Information Collection

Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim

IC 13697 under ICR 202604-1240-001 · OMB 1240-0033.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CM-2970 OPERATOR RESPONSE TO SCHEDULE FOR SUBMISSION OF ADDITIONAL EVIDENCE Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim	Form
Form CM-2970a OPERATOR RESPONSE TO NOTICE OF CLAIM Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim	Form
CM-2970 OPERATOR RESPONSE TO SCHEDULE FOR SUBMISSION OF ADDITION CM-2970 Form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Form
CM-2970a OPERATOR RESPONSE TO NOTICE OF CLAIM CM-2970a Form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 725.412a 20 CFR 725.408(a)(2)

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	CM-2970			https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable
Form	CM-2970a			https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: DOL/OWCP-2 and DOL/OWCP-9

FR Citation: 81 FR 25858

Number of Respondents: 11,470

Number of Respondents for Small Entity: 4,900

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 70 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	11,470	3,240	2,936	5,294
Annual IC Time Burden (Hours)	2,644	0	1,471	1,173
Annual IC Cost Burden (Dollars)	2,923	0	1,827	1,096

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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