Statement of Recovery Forms

OMB 1240-0001

OMB 1240-0001

These forms are used to obtain information about amounts received as the result of final judgments in litigation, or a settlement of the litigation, brought against a third party who is liable for damages due to a Federal employee comprehensive work-related injury.

The latest form for Statement of Recovery Forms expires 2022-02-28 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form and Instruction
Form and Instruction
Justification for No Material/Nonsubstantive Change
Supplementary Document
Supplementary Document
Supporting Statement A
Supplementary Document
Supplementary Document
Supplementary Document
All Historical Document Collections
 No material or nonsubstantive change to a currently approved collection 2024-04-24
Approved without change
 Extension without change of a currently approved collection 2022-01-11
Approved without change
 Revision of a currently approved collection 2018-11-30
Approved without change
 No material or nonsubstantive change to a currently approved collection 2016-09-12
Approved without change
 Revision of a currently approved collection 2015-08-07
Approved without change
 Revision of a currently approved collection 2012-05-11
Approved without change
 Extension without change of a currently approved collection 2010-03-12
OMB Details

Statement of Recovery Forms

Federal Enterprise Architecture: Workforce Management - Labor Rights Management

Form CA-1108Statement of Recovery www.dol.gov/owcp/dfec/regs/compliance/forms.htmForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.

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