OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Claim for Medical Reimbursement Form

OMB 1215-0193 · DOL/ESA.

OMB 1215-0193
Latest Forms, Documents, and Supporting Material
Document
Name
Form and Instruction
Supporting Statement A
All Historical Document Collections
Approved without change
 Extension without change of a currently approved collection 2009-11-17
Approved without change
 Extension without change of a currently approved collection 2007-01-03
Approved without change
 No material or nonsubstantive change to a currently approved collection 2005-06-29
Approved without change
 Revision of a currently approved collection 2003-11-25
Approved without change
 Extension without change of a currently approved collection 2000-11-28
Approved without change
 New collection (Request for a new OMB Control Number) 1997-12-17