Request for Earnings Information

Request for Earnings Information Report

OMB: 1240-0025

IC ID: 13778

Information Collection (IC) Details

View Information Collection (IC)

Request for Earnings Information
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction LS-426 Request for Earnings Information ls-426.pdf https://www.dol.gov/owcp/dlhwc/ls-426.pdf Yes No Fillable Printable

Income Security General Retirement and Disability

DOL/ ESA-15  67 FR 16886

100 0
   
Individuals or Households
 
   13 %

  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 100 0 0 0 0 100
Annual IC Time Burden (Hours) 25 0 0 0 0 25
Annual IC Cost Burden (Dollars) 1 0 -22 0 0 23

Title Document Date Uploaded
DLHWC SEA Portal DLHWC Seaportal.pdf 09/24/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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