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Statement of Recovery Forms
Statement of Recovery Forms
OMB: 1240-0001
IC ID: 13938
OMB.report
DOL/OWCP
OMB 1240-0001
ICR 202409-1240-003
IC 13938
( )
Documents and Forms
Document Name
Document Type
Form CA-1108
Statement of Recovery Forms
Form and Instruction
CA-1108 Statement of Recovery
CA-1108.pdf
www.dol.gov/agencies/owcp/FECA/regs/compliance/forms
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
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:
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.pdf
https://www.dol.gov/agencies/owcp/FECA/regs/compliance/forms
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
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:
1,114
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
97 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,114
0
0
-40
0
1,154
Annual IC Time Burden (Hours)
557
0
0
-20
0
577
Annual IC Cost Burden (Dollars)
20
0
0
-1
0
21
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.