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1240-0016 Supporting Statement final
1240-0016 Supporting Statement final.docx
Request for Information on Earnings, Dual Benefits, Dependents, and Third Party Settlements
OMB: 1240-0016
OMB.report
DOL/OWCP
OMB 1240-0016
ICR 202304-1240-010
1240-0016 Supporting Statement final
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0016 can be found here:
2023-09-25 - Extension without change of a currently approved collection
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