Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements

Request for Information on Earnings, Dual Benefits, Dependents, and Third Party Settlements

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0016 can be found here:

Documents and Forms

Document Name Document Type
Form CA-1032 Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements Form and Instruction
CA-1032 Request for Information on Earnings, Dual Benefits, Depe Request for Information on Earnings Dual Benefits Dependents and Third Party Settlements (CA-1032).docx Form and Instruction

Information Collection (IC) Details

IC Title:	Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 10.528

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CA-1032	Request for Information on Earnings, Dual Benefits, Dependents, and Third Party Settlement	Request for Information on Earnings Dual Benefits Dependents and Third Party Settlements (CA-1032).docx		No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/GOVT-1	FR Citation: 81 FR 47418

Number of Respondents: 37,056	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 26 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	37,056	0	37,056
Annual IC Time Burden (Hours)	12,228	-124	12,352
Annual IC Cost Burden (Dollars)	15,030	0	15,030

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.