Request for Information on Earnings, Dual Benefits, Dependents and Third Part Settlements

Request for Information on Earnings, Dual Benefits, Dependents and Third Party Settlements

OMB: 1240-0016

IC ID: 13834

Information Collection (IC) Details

View Information Collection (IC)

Request for Information on Earnings, Dual Benefits, Dependents and Third Part Settlements
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 10.528

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CA-1032 Request for Information on Earnings, Dual Benefits, Dependents, and Third Party Settlement CA-1032 Revised.doc No   Paper Only

Income Security Survivor Compensation

DOL/GOVT-1  67 FR 16826

44,800 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 44,800 0 0 -5,200 0 50,000
Annual IC Time Burden (Hours) 14,933 0 0 -1,734 0 16,667
Annual IC Cost Burden (Dollars) 23,296 0 0 -204 0 23,500

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