Document

CHANGE WORKSHEET FOR OMB NO

ICR 201309-1240-005 · OMB 1240-0014 · Object 43975501.

Document Viewer [docx]

Status: The document is viewable, but some background extraction is still pending.

Queue: Repair is in progress, but the document is still incomplete and remains in the worker queue. (priority 70 · next 2026-06-12 00:50:55)

Missing: html

Download: Source copy (docx)

Primary: docxSource: application/vnd.openxmlformats-officedocument.wordprocessingml.document
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Document Metadata
File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleCHANGE WORKSHEET FOR OMB NO
AuthorUS Department of Labor
File Created2021-01-28
Conversion Statepartial