OMB control number

Application For Self-insurance

OMB 1215-0062 · DOL/ESA.

OMB 1215-0062

Latest Forms, Documents, and Supporting Material

Document Name
APPLICATION FOR SELF-INSURANCE Form

All Historical Document Collections

198206-1215-006 Approved with change	No material or nonsubstantive change to a currently approved collection	1982-06-30
198006-1215-001 Approved with change	No material or nonsubstantive change to a currently approved collection	1980-06-18
198005-1215-002 Approved without change	Revision of a currently approved collection	1980-05-27
197505-1215-001 Approved without change	Revision of a currently approved collection	1975-05-29