OMB control number
Notice To Carrier Or Self-insurer Employer
OMB 1215-0101 ยท DOL/ESA.
OMB 1215-0101
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 NOTICE TO CARRIER OR SELF-INSURER EMPLOYER |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 198012-1215-004 | New collection (Request for a new OMB Control Number) | 1980-12-08 | Approved without change |