Request for Information on Earnings, Dual Benefits, Dependents, and Third Party Settlements

OMB 1240-0016

Form CA-1032 is used to obtain information from claimants receiving compensation for an extended period of time. This information is necessary to ensure that compensation being paid is correct.

The latest form for Request for Information on Earnings, Dual Benefits, Dependents, and Third Party Settlements expires 2023-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CA-1032 Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements Form and Instruction
Updated Average hourly and weekly earnings of production and nonsupervisory employees.pdf Supplementary Document
ECOMP 1032 PART B Volunteer work.updated.docx Supplementary Document
5 USC 8105, 8106, 8110, 8132, and 8148.docx Supplementary Document
20 CFR 10.528.docx Supplementary Document
DOL GOVT-1.docx Supplementary Document
Rest of U.S. OPM Salary Table. 2023.pdf Supplementary Document
ECOMP 1032 Part H Certification .docx Supplementary Document
ECOMP 1032 Part G Corrections .docx Supplementary Document
ECOMP 1032 Part F Fraud Offenses.docx Supplementary Document
ECOMP 1032. Part E Third-Party Settlement .docx Supplementary Document
ECOMP 1032. Part D Other Federal Benefits or Payments .docx Supplementary Document
ECOMP 1032. Part C Dependents .docx Supplementary Document
ECOMP 1032. Part A Employment .docx Supplementary Document
ECOMP 1032 Print Screen Shots.docx Supplementary Document
1240-0016 Supporting Statement .5.22.23 mjs 5.26.23_MN.updated 9.19.23_MN,clean copy.docx Supporting Statement A
Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements Form and Instruction

All Historical Document Collections

202306-1240-003 Approved without change	Extension without change of a currently approved collection	2023-09-25
202304-1240-010 Approved with change	No material or nonsubstantive change to a currently approved collection	2023-05-04
202104-1240-001 Approved without change	Revision of a currently approved collection	2022-01-21
202003-1240-006 Approved without change	Extension without change of a currently approved collection	2020-08-19
201701-1240-003 Approved without change	Revision of a currently approved collection	2017-05-31
201310-1240-001 Approved without change	Revision of a currently approved collection	2014-03-31
201008-1240-002 Approved without change	Revision of a currently approved collection	2011-02-25
201003-1240-016 Approved without change	Extension without change of a currently approved collection	2010-03-12