OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Notice of Law Enforcement Officer's Injury or Occupational Disease (CA-721); Notice of Law Enforcement Officer's Death (CA-722)

IC 13785 under ICR 202410-1240-001 · OMB 1240-0022.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form CA-721
Notice of Law Enforcement Officer's Injury or Occupational Disease (CA-721); Notice of Law Enforcement Officer's Death (CA-722)		 Form and Instruction
Form CA-721
Notice of Law Enforcement Officer's Injury or Occupational Disease Notice of Law Enforcement Officer's Injury or Occupational Disease (CA-721); Notice of Law Enforcement Officer's Death (CA-722)		 Form and Instruction
Form CA-722
Notice of Law Enforcement Officer's Death Notice of Law Enforcement Officer's Injury or Occupational Disease (CA-721); Notice of Law Enforcement Officer's Death (CA-722)		 Form and Instruction
CA-721 Notice of Law Enforcement Officer's Injury or Occupation
ca-721 with proposed change.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm 		Form and Instruction
CA-721 Notice of Law Enforcement Officer's Injury or Occupation
ca-721 with proposed change.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm 		Form and Instruction
CA-722 Notice of Law Enforcement Officer's Death
ca-722 with proposed changed.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm 		Form and Instruction
CA-722 Notice of Law Enforcement Officer's Death
ca-722 with proposed changed.pdf
www.dol.gov/owcp/dfec/regs/compliance/forms.htm 		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-721 http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm Yes No Fillable Printable
Form and Instruction CA-722 http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm Yes No Fillable Printable

Federal Enterprise Architecture Business Reference Module


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  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 2 0 0 0 0 2
Annual IC Time Burden (Hours) 3 0 0 0 0 3
Annual IC Cost Burden (Dollars) 3 0 0 0 0 3

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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