RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { border-color: transparent; background-color: transparent; left: 250px; top:75px; width:1px; height:1px; color:black; overflow:hid

ICR 202010-0960-011

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0960-0247 can be found here:

Forms and Documents

Document Name	Status
Supporting Statement - 0247.docx Supporting Statement A	2021-01-28

IC Document Collections

IC ID	Document Title	Status
9165	Workers' Compensation/Public Disability Benefit Questionnaire Other-Inernal Intranet Screens	Modified

ICR Details