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 january 2017 cpc suggest jv (2) mjs 2-21-2017ad final 2-22-2017.doc No   Paper Only

Income Security Survivor Compensation

DOL/GOVT-1  67 FR 16826

45,161 0
   
Individuals or Households
 
   25 %

  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 45,161 0 0 361 0 44,800
Annual IC Time Burden (Hours) 15,054 0 0 121 0 14,933
Annual IC Cost Burden (Dollars) 5,166 0 0 -18,130 0 23,296

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