OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Statement of Recovery

IC 188783 under ICR 202409-1240-003 · OMB 1240-0001.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form CA-1122
Statement of Recovery		 Form and Instruction
Form CA-1122
Statement of Recovery Statement of Recovery		 Form and Instruction
CA-1122 Statement of Recovery
ca-1122.pdf
www.dol.gov/agencies/owcp/FECA/regs/compliance/forms 		Form and Instruction
CA-1122 Statement of Recovery
ca-1122.pdf
www.dol.gov/agencies/owcp/FECA/regs/compliance/forms 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-1122 https://www.dol.gov/agencies/owcp/FECA/regs/compliance/forms Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved 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 278 0 0 268 0 10
Annual IC Time Burden (Hours) 83 0 0 80 0 3
Annual IC Cost Burden (Dollars) 5 0 0 5 0 0

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.
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