Information Collection Request
Request for Information on Earnings, Dual Benefits, Dependents, and Third Party Settlements
ICR 202304-1240-010 · OMB 1240-0016 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1240-0016 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CA-1032 Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements |
Form and Instruction | Unchanged | Available |
| Form CA-1032 Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements |
Form and Instruction | Unchanged | Repair queued |
 revised justification for ca-1032 electronic version 5 10 23.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-05-10 | Available |
| justification for ca-1032 electronic version.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-05-04 | Available |
| justification for ca-1032 electronic version.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-05-04 | Repair queued |
| ECOMP 1032 Part H Certification .docx |
Supplementary Document | Uploaded 2023-04-26 | Available |
| ECOMP 1032 Part H Certification .docx |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
| ECOMP 1032 Part G Corrections .docx |
Supplementary Document | Uploaded 2023-04-26 | Available |
| ECOMP 1032 Part G Corrections .docx |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
| ECOMP 1032 Part F Fraud Offenses.docx |
Supplementary Document | Uploaded 2023-04-26 | Available |
| ECOMP 1032 Part F Fraud Offenses.docx |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
| ECOMP 1032. Part E Third-Party Settlement .docx |
Supplementary Document | Uploaded 2023-04-26 | Available |
| ECOMP 1032. Part E Third-Party Settlement .docx |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
| ECOMP 1032. Part D Other Federal Benefits or Payments .docx |
Supplementary Document | Uploaded 2023-04-26 | Available |
| ECOMP 1032. Part D Other Federal Benefits or Payments .docx |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
| ECOMP 1032. Part C Dependents .docx |
Supplementary Document | Uploaded 2023-04-26 | Available |
| ECOMP 1032. Part C Dependents .docx |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
| ECOMP 1032 Part B Volunteer Work.docx |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
| ECOMP 1032 Part B Volunteer Work.docx |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
| ECOMP 1032. Part A Employment .docx |
Supplementary Document | Uploaded 2023-04-26 | Available |
| ECOMP 1032. Part A Employment .docx |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
| ECOMP 1032 Print Screen Shots.docx |
Supplementary Document | Uploaded 2023-04-26 | Available |
| ECOMP 1032 Print Screen Shots.docx |
Supplementary Document | Uploaded 2023-04-26 | Repair queued |
| 1240-0016 Supporting Statement final revised mjs 5.9.2023 final 2.docx |
Supporting Statement A | Uploaded 2023-05-10 | Available |
| 1240-0016 Supporting Statement final.docx |
Supporting Statement A | Uploaded 2022-01-14 | Missing upstream |
| 20 cfr 10.528.docx |
Supplementary Document | Uploaded 2020-03-20 | Available |
| 20 cfr 10.528.docx |
Supplementary Document | Uploaded 2020-03-20 | Repair queued |
| DOL GOVT-1.docx |
Supplementary Document | Uploaded 2020-03-20 | Available |
| DOL GOVT-1.docx |
Supplementary Document | Uploaded 2020-03-20 | Repair queued |
 opm salary table 2020.pdf |
Supplementary Document | Uploaded 2020-03-20 | Available |
| opm salary table 2020.pdf |
Supplementary Document | Uploaded 2020-03-20 | Repair queued |
| Average hourly and weekly earnings of production and nonsupervisory employees on private nonfarm payrolls by industry sector, seasonally adjusted.docx |
Supplementary Document | Uploaded 2020-03-20 | Available |
| Average hourly and weekly earnings of production and nonsupervisory employees on private nonfarm payrolls by industry sector, seasonally adjusted.docx |
Supplementary Document | Uploaded 2020-03-20 | Repair queued |
| 5 USC Sections 8105, 8106, 8110, 8132 and 8148.docx |
Supplementary Document | Uploaded 2020-03-20 | Available |
| 5 USC Sections 8105, 8106, 8110, 8132 and 8148.docx |
Supplementary Document | Uploaded 2020-03-20 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 13834 |  Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements |
Form and Instruction | Unchanged | |
| 13834 | Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements |
Form and Instruction | Unchanged |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | DOL/OWCP |
| OMB Control No | 1240-0016 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202104-1240-001 |
| Date Submitted to OIRA | 2023-05-04 |
| Requested Expiration Date | 1969-12-31 |