View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Claim for Compensation by a Dependent Information Reports
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 10.535 20 CFR 10.537 20 CFR 10.7 20 CFR 10.410 20 CFR 10.413 20 CFR 10.417 20 CFR 10.105

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other- No   Paper Only
Other- Yes Yes Paper Only
Form and Instruction CA-5 https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-5.pdf Yes Yes Fillable Fileable
Form and Instruction CA-5b https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-5b.pdf Yes Yes Fillable Fileable
Form CA-1031 https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1031.pdf Yes Yes Printable Only
Form CA-1074 https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1074.pdf Yes Yes Printable Only

Income Security Survivor Compensation

DOL/GOVT-1  81 FR 47418

1,241 0
   
Individuals or Households
 
   71 %

  Requested 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 1,241 0 0 0 0 1,241
Annual IC Time Burden (Hours) 1,063 0 0 0 0 1,063
Annual IC Cost Burden (Dollars) 730 0 0 174 0 556

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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