Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act

Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act

OMB: 1240-0006

IC ID: 13940

Information Collection (IC) Details

View Information Collection (IC)

Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 61.104 20 CFR 61.101

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CA-278 Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act ca-278 unsecured.pdf http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm No   Fillable Printable

Income Security Survivor Compensation

DOL/GOVT-1  67 FR 16826

7 0
   
Private Sector Businesses or other for-profits
 
   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 345 0 0 -48 0 393
Annual IC Time Burden (Hours) 173 0 0 -24 0 197
Annual IC Cost Burden (Dollars) 542 0 0 -865 0 1,407

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