Claim for Continuance of Compensation

Claim for Continuance of Compensation (CA-12)

OMB: 1240-0015

IC ID: 13838

Information Collection (IC) Details

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Claim for Continuance of Compensation
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
20 CFR 10.126

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CA-12 Claim for Continuance of Compensation Under the Federal Employees' Compensation ACt ca-12.pdf https://www.dol.gov/owcp/regs/compliance/ca-12.pdf Yes No Fillable Printable

Income Security Survivor Compensation

DOL/GOVT-1  67 FR 16817

3,552 0
   
Individuals or Households
 
   1 %

  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 3,552 0 0 0 0 3,552
Annual IC Time Burden (Hours) 295 0 0 0 0 295
Annual IC Cost Burden (Dollars) 1,847 0 0 0 0 1,847

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