OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Survivor's Form for Benefits

OMB 1215-0069 ยท DOL/ESA.

OMB 1215-0069

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CM-912 Survivor's Form for BenefitsForm
DOL Privacy Act systems ESA-30.pdf Supplementary Document
DOL Privacy Act systems ESA-6.pdf Supplementary Document
SS for 1215-0069 (CM-912) February 2007.docSupporting Statement A
Survivor's Form for Benefits Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
200703-1215-004 Extension without change of a currently approved collection 2007-06-14 Approved without change
200406-1215-005 Extension without change of a currently approved collection 2004-06-15 Approved without change
200106-1215-002 Extension without change of a currently approved collection 2001-06-13 Approved without change
199806-1215-001 Revision of a currently approved collection 1998-06-09 Approved without change
199601-1215-002 Extension without change of a currently approved collection 1996-01-26 Approved without change
199502-1215-002 Extension without change of a currently approved collection 1995-02-21 Approved without change
199202-1215-001 Revision of a currently approved collection 1992-02-13 Approved without change
198905-1215-003 Revision of a currently approved collection 1989-05-04 Approved without change
198904-1215-019 No material or nonsubstantive change to a currently approved collection 1989-04-24 Approved with change
198605-1215-008 Revision of a currently approved collection 1986-05-30 Approved without change
198309-1215-030 No material or nonsubstantive change to a currently approved collection 1983-09-06 Approved with change
198309-1215-006 Revision of a currently approved collection 1983-09-26 Approved without change
198307-1215-004 No material or nonsubstantive change to a currently approved collection 1983-07-22 Approved with change
197812-1215-008 No material or nonsubstantive change to a currently approved collection 1978-12-31 Approved with change
197808-1215-010 Revision of a currently approved collection 1978-08-17 Approved without change