OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

FECA Medical Report Forms, Claim for Compensation

OMB 1215-0103 ยท DOL/ESA.

OMB 1215-0103

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form ca-16 Authorization for Examination and/or TreatmentForm and Instruction
Form ca-20 Attending Physicians ReportForm and Instruction
Form owcp-5c Work Capacity Evaluation FormForm and Instruction
Form owcp-5b Work Capacity EvaluationForm and Instruction
Form OWCP-5A Work Capacity EvaluationForm and Instruction
Form CA-1332 Outline for Otologic TestingForm and Instruction
Form CA-1331 Authorization to doctor for audiologic and otologic evaluationForm and Instruction
Form CA-17 Duty Status ReportForm and Instruction
Form CA-7 Claim for CompensationForm and Instruction
Form ca-17 Duty Status ReportForm and Instruction
1215-0103 OMB Form 83-12.doc Supplementary Document
Supporting Statement for 1215-0103 (Various CA Forms) July 15 2008.docSupporting Statement A
THE PRIVACY ACT OF 1974.doc Supplementary Document
DOL_GOVT-1.doc Supplementary Document
Compensation Act.doc Supplementary Document
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction
FECA Medical Report Forms, Claim for Compensation Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
200803-1215-005 Extension without change of a currently approved collection 2008-08-07 Approved without change
200507-1215-001 Extension without change of a currently approved collection 2005-07-01 Approved without change
200501-1215-002 No material or nonsubstantive change to a currently approved collection 2005-01-10 Approved without change
200303-1215-001 No material or nonsubstantive change to a currently approved collection 2003-03-05 Approved without change
200207-1215-001 Revision of a currently approved collection 2002-07-03 Approved without change
199908-1215-002 Extension without change of a currently approved collection 1999-08-18 Approved without change
199807-1215-005 Revision of a currently approved collection 1998-07-28 Approved without change
199608-1215-001 Revision of a currently approved collection 1996-08-05 Approved without change
199509-1215-002 Revision of a currently approved collection 1995-09-19 Approved without change
199306-1215-004 Revision of a currently approved collection 1993-06-29 Approved without change
199107-1215-004 Revision of a currently approved collection 1991-07-25 Approved without change
198807-1215-003 Revision of a currently approved collection 1988-07-21 Approved without change
198511-1215-001 Revision of a currently approved collection 1985-11-22 Approved without change
198503-1215-004 No material or nonsubstantive change to a currently approved collection 1985-03-25 Approved with change
198402-1215-004 Extension without change of a currently approved collection 1984-02-22 Approved without change
198309-1215-007 Revision of a currently approved collection 1983-09-26 Approved without change
198211-1215-003 Revision of a currently approved collection 1982-11-10 Approved without change
198206-1215-003 No material or nonsubstantive change to a currently approved collection 1982-06-30 Approved with change
198012-1215-006 New collection (Request for a new OMB Control Number) 1980-12-08 Approved without change