Request for Employment Information

ICR 201003-1240-047

OMB: 1240-0047

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2009-08-10
Supplementary Document
2009-08-10
Supplementary Document
2009-07-10
Supplementary Document
2009-07-10
Supporting Statement A
2009-10-27
IC Document Collections
IC ID
Document
Title
Status
13773 Modified
ICR Details
1240-0047 201003-1240-047
Historical Active 200611-1215-003
DOL/OWCP
Request for Employment Information
Extension without change of a currently approved collection   No
Regular
Approved without change 03/12/2010
Retrieve Notice of Action (NOA) 03/12/2010
  Inventory as of this Action Requested Previously Approved
12/31/2012 36 Months From Approved
500 0 500
125 0 125
235 0 210

This information collection is used to collect information about a claimant's employment. It is necessary to determine continued eligibility for compensation payments under FECA.

US Code: 5 USC 8106 Name of Law: Federal Employees' Compensation Act
  
None

Not associated with rulemaking

  74 FR 42124 08/20/2009
74 FR 59243 11/17/2009
No

1
IC Title Form No. Form Name
Request for Employment Information CA-1027 Request for Employer Information

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 500 500 0 0 0 0
Annual Time Burden (Hours) 125 125 0 0 0 0
Annual Cost Burden (Dollars) 235 210 0 0 25 0
No
No

$4,695
No
No
Uncollected
Uncollected
No
Uncollected
Marcus Sharpless 202 693-0998 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/17/2009


© 2024 OMB.report | Privacy Policy