OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Representative Fee Request

OMB 1240-0049 ยท DOL/OWCP.

OMB 1240-0049

Individuals filing for compensation benefits with OWCP may be represented by an attorney or other representative. The representative is entitled to request a fee for services under the Federal Employees' Compensation Act (FECA). The fee must be approved by the OWCP before any demand for payment can be made by the representative. This information collection request sets forth the criteria for the information, which must be presented by the respondent in order to have the fee approved by OWCP. The information collection does not have a particular form or format; the respondent must present the information in any format which is convenient and which meets all of the required criteria.

The latest form for Representative Fee Request expires 2028-06-30 and is listed under ICR 202503-1240-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CA-143 and CA-155 Attorney Fee RequestForm and Instruction
Form CA-143 and CA-155 Representative Fee RequestForm and Instruction
Supporting Statement for 1240-0049_20250422.docxSupporting Statement A
Comments Recvd re Attorney Fee Requests.pdf (document unavailable)Public Comments
20 cfr 10.700 tp 10.703.docxSupplementary Document
Privacy Act Systems-FECA.docxSupplementary Document
OPM Pay Table 2024 RUS.pdfSupplementary Document
Representative Fee Request Form and Instruction
Representative Fee Request Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202503-1240-001 Revision of a currently approved collection 2025-04-30
202204-1240-002 Revision of a currently approved collection 2022-05-24 Approved without change
201903-1240-001 Extension without change of a currently approved collection 2019-05-31 Approved without change
201508-1240-002 Extension without change of a currently approved collection 2016-01-29 Approved without change
201209-1240-005 Revision of a currently approved collection 2012-12-14 Approved with change
201003-1240-049 Extension without change of a currently approved collection 2010-03-26 Approved without change