Information Collection

Rehabilitation Maintenance Certificate

IC 43809 under ICR 202502-1240-004 · OMB 1240-0012.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OWCP-17 Rehabilitation Maintenance Certificate	Form
Form OWCP-17 Rehabilitation Maintenance Certificate Rehabilitation Maintenance Certificate	Form
OWCP-17 Rehabilitation Maintenance Certificate owcp-17 with proposed changes.pdf www.dol.gov/owcp/dfec/regs/compliance/forms.htm	Form
OWCP-17 Rehabilitation Maintenance Certificate owcp-17 with proposed changes.pdf www.dol.gov/owcp/dfec/regs/compliance/forms.htm	Form

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OWCP-17			http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: DOL/GOVT-1 (FECA); DOL/OWCP-3; DOL/OWCP-4 (Longshore)

FR Citation: 81 FR 47418

Number of Respondents: 148

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,288	-2,164	3,452
Annual IC Time Burden (Hours)	215	-360	575
Annual IC Cost Burden (Dollars)	0	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].