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

View Information Collection (IC)

Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 61.101 20 CFR 61.104

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CA-278 https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-278.pdf Yes Yes Fillable Printable
Form and Instruction WH-1 https://www.dol.gov/agencies/owcp/FECA/regs/compliance/forms Yes Yes Fillable Printable

Income Security Survivor Compensation

DOL/GOVT-1  81 FR 47418

14 0
   
Private Sector Businesses or other for-profits
 
   0 %

  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 2,528 0 1,264 0 0 1,264
Annual IC Time Burden (Hours) 1,264 0 632 0 0 632
Annual IC Cost Burden (Dollars) 5,840 0 0 3,413 0 2,427

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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