OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Health Insurance Claim Form

OMB 1215-0055 · DOL/ESA.

OMB 1215-0055
Latest Forms, Documents, and Supporting Material
Document
Name
Form
Supplementary Document
Supporting Statement A
Supplementary Document
Supplementary Document
Supplementary Document
All Historical Document Collections
Approved without change
 Revision of a currently approved collection 2009-08-24
Approved without change
 No material or nonsubstantive change to a currently approved collection 2006-10-31
Approved without change
 Extension without change of a currently approved collection 2006-07-10
Approved without change
 No material or nonsubstantive change to a currently approved collection 2005-06-29
Approved without change
 Extension without change of a currently approved collection 2003-09-26
Approved without change
 No material or nonsubstantive change to a currently approved collection 2001-08-03
Approved without change
 Extension without change of a currently approved collection 2000-09-21
Approved without change
 Extension without change of a currently approved collection 1997-09-24
Approved without change
 No material or nonsubstantive change to a currently approved collection 1996-08-15
Approved without change
 Revision of a currently approved collection 1994-09-01
Approved with change
 No material or nonsubstantive change to a currently approved collection 1994-07-13
Approved without change
 Revision of a currently approved collection 1993-07-22
Approved with change
 No material or nonsubstantive change to a currently approved collection 1993-06-29
Approved with change
 No material or nonsubstantive change to a currently approved collection 1991-11-19
Approved without change
 Revision of a currently approved collection 1991-11-21
Approved without change
 Revision of a currently approved collection 1991-03-14
Approved without change
 Revision of a currently approved collection 1990-08-01
Approved without change
 Revision of a currently approved collection 1987-10-19
Approved without change
 Revision of a currently approved collection 1984-07-23
Approved with change
 No material or nonsubstantive change to a currently approved collection 1983-09-06
Approved without change
 Revision of a currently approved collection 1982-06-21
Approved without change
 Revision of a currently approved collection 1978-08-17
Approved without change
 Extension without change of a currently approved collection 1978-06-29