OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Statement of Recovery Forms

OMB 1240-0001 ยท DOL/OWCP.

OMB 1240-0001

These OWCP 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 2027-12-31 and is listed under ICR 202409-1240-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CA-1122 Statement of RecoveryForm and Instruction
Form CA-1122 Statement of RecoveryForm and Instruction
Form CA-1108 Statement of RecoveryForm and Instruction
Form CA-1108 Statement of Recovery FormsForm and Instruction
Supporting Statement 1240-0001_Final.docxSupporting Statement A
Supporting Statement 1240-0001_Final.docxSupporting Statement A
60 day FRN 1240-0001. 9.5.24.pdfSupplementary Document
60 day FRN 1240-0001. 9.5.24.pdf Supplementary Document
BLS Current Employment July 2024.pdfSupplementary Document
May 2023 Occupational Employment and Wage Statistics.pdfSupplementary Document
May 2023 Occupational Employment and Wage Statistics.pdf Supplementary Document
owcp feca privacy act system of records (1).docxSupplementary Document
owcp feca privacy act system of records (1).docx Supplementary Document
Statement of Recovery Form and Instruction
Statement of Recovery Form and Instruction
Statement of Recovery Forms Form and Instruction
Statement of Recovery Forms Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202409-1240-003 Extension without change of a currently approved collection 2024-11-21
202404-1240-004 No material or nonsubstantive change to a currently approved collection 2024-04-24 Approved without change
202109-1240-001 Extension without change of a currently approved collection 2022-01-11 Approved without change
201808-1240-001 Revision of a currently approved collection 2018-11-30 Approved without change
201609-1240-002 No material or nonsubstantive change to a currently approved collection 2016-09-12 Approved without change
201504-1240-001 Revision of a currently approved collection 2015-08-07 Approved without change
201202-1240-002 Revision of a currently approved collection 2012-05-11 Approved without change
201003-1240-001 Extension without change of a currently approved collection 2010-03-12 Approved without change

OMB Details

Statement of Recovery Forms

Federal Enterprise Architecture: Workforce Management - Labor Rights Management

Information collection instruments
FormNameElectronic accessType
Form CA-1108Statement of Recoverywww.dol.gov/agencies/owcp/FECA/regs/compliance/formsForm and instruction

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