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Survivor's Form for Benefits
OMB 1215-0069
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DOL/ESA
OMB 1215-0069
OMB 1215-0069
Latest Forms, Documents, and Supporting Material
Document
Name
Form CM-912 Survivor's Form for Benefits
Form
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.doc
Supporting Statement A
Survivor's Form for Benefits
Form
All Historical Document Collections
200703-1215-004
Approved without change
Extension without change of a currently approved collection
2007-06-14
200406-1215-005
Approved without change
Extension without change of a currently approved collection
2004-06-15
200106-1215-002
Approved without change
Extension without change of a currently approved collection
2001-06-13
199806-1215-001
Approved without change
Revision of a currently approved collection
1998-06-09
199601-1215-002
Approved without change
Extension without change of a currently approved collection
1996-01-26
199502-1215-002
Approved without change
Extension without change of a currently approved collection
1995-02-21
199202-1215-001
Approved without change
Revision of a currently approved collection
1992-02-13
198905-1215-003
Approved without change
Revision of a currently approved collection
1989-05-04
198904-1215-019
Approved with change
No material or nonsubstantive change to a currently approved collection
1989-04-24
198605-1215-008
Approved without change
Revision of a currently approved collection
1986-05-30
198309-1215-030
Approved with change
No material or nonsubstantive change to a currently approved collection
1983-09-06
198309-1215-006
Approved without change
Revision of a currently approved collection
1983-09-26
198307-1215-004
Approved with change
No material or nonsubstantive change to a currently approved collection
1983-07-22
197812-1215-008
Approved with change
No material or nonsubstantive change to a currently approved collection
1978-12-31
197808-1215-010
Approved without change
Revision of a currently approved collection
1978-08-17
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