Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Supplemental Information on Accident and Insurance Modified 530 45 0 Form and Instruction SI-1C (03-09) Supplemental Information on Accident and Insurance
Form ID-30K (03-02) Notice to Request Supplemental Information on Injury or Illness
Supplemental Information on Accident and Insurance Modified 10272 516 0 Form and Instruction SI-5 (12-93) Report of Payments to Employee Claiming Sickness Benefits Under the RUIA
Form and Instruction ID-3S (03-09) Request for Lien Information; Report of Settlement
Form and Instruction ID-3S-1 (03-09) Lien Information Under Section 12(o) of the RUIA
Form and Instruction ID-3U (03-09) Request for Section 2(f) Information
Form and Instruction ID-30K-1 (03-02) Request for Supplemental Information on Injury or Illness - 3rd party
Form and Instruction ID-3S (Internet) (proposed) Request for Lien Information; Report of Settlement
Form and Instruction ID-3U (Internet) (proposed) Request for Section 2(f) Information
Total burden requested under this ICR: 10802 561 0  
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