OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 1240-0016 · DOL/OWCP.

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 2026-11-30 and is listed under ICR 202306-1240-003.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CA-1032 Request for Information on Earnings, Dual Benefits, Dependents, and Third Party SettlementForm and Instruction
Form CA-1032 Request for Information on Earnings, Dual Benefits, Dependents, and Third Part SettlementsForm 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.docxSupporting Statement A
Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements Form and Instruction
Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements Form and Instruction

All Historical Document Collections

Historical document collections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