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View Information Collection (IC)

View Information Collection (IC)

FECA Medical Report Forms, Claim for Compensation
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 10.506 20 CFR 10.102 20 CFR 10.331 20 CFR 10.300 20 CFR 10.314 20 CFR 10.211

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CA-7 revised http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm Yes Yes Fillable Printable
Form and Instruction CA-17 http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm Yes No Fillable Printable
Form and Instruction OWCP-5a http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm Yes No Fillable Printable
Form and Instruction owcp-5b http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm Yes No Fillable Printable
Form and Instruction owcp-5c http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm ca-5c.pdf Yes No Fillable Printable
Form and Instruction CA-20 http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm Yes No Fillable Printable
Form and Instruction ca-16 https://www.dol.gov/agencies/owcp/FECA/regs/compliance/forms. No   Paper Only
Form and Instruction CA-1305 No   Paper Only
Form and Instruction CA-1332 No   Paper Only
Form and Instruction CA-1331 with CA-1087 enclosure No   Paper Only
Form and Instruction CA-1090 No   Paper Only
Form and Instruction CA-17 http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm Yes No Fillable Printable
Form and Instruction CA-20 http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm Yes No Fillable Printable
Form and Instruction OWCP-5a http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm Yes No Fillable Printable
Form and Instruction OWCP-5b http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm Yes No Fillable Printable
Form and Instruction OWCP-5c http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm ca-5c.pdf Yes No Fillable Printable

Workforce Management Labor Rights Management

DOL/GOVT-1  81 FR 47418

282,353 0
   
Individuals or Households
 
   25 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 282,353 0 0 0 0 282,353
Annual IC Time Burden (Hours) 25,605 0 0 0 0 25,605
Annual IC Cost Burden (Dollars) 133,412 0 0 0 0 133,412

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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