Information Collection

Statement of Recovery Forms

IC 13938 under ICR 202109-1240-001 · OMB 1240-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CA-1108 Statement of Recovery Forms	Form and Instruction
CA-1108 Statement of Recovery ca-1108 final.pdf www.dol.gov/agencies/owcp/FECA/regs/compliance/forms	Form and Instruction
CA-1108 Statement of Recovery ca-1108 final.pdf www.dol.gov/agencies/owcp/FECA/regs/compliance/forms	Form and Instruction

IC Title:

Statement of Recovery Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CA-1108	Statement of Recovery	ca-1108 final.pdf	https://www.dol.gov/agencies/owcp/FECA/regs/compliance/forms	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: DOL/GOVT-1

FR Citation: 81 FR 47418

Number of Respondents: 1,154

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 97 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,154	226	928
Annual IC Time Burden (Hours)	577	113	464
Annual IC Cost Burden (Dollars)	21	-225	246

Documents for IC

table that charts IC Documents
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.