View Information Collection (IC)

View Information Collection (IC)

Claim for Continuance of Compensation
No Modified
Required to Obtain or Retain Benefits
20 CFR 10.126

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CA-12 Claim for Continuance of Compensation Under the Federal Employees' Compensation Act CA-12_working.pdf Yes No Fillable Printable

Income Security Survivor Compensation

DOL/GOVT-1  67 FR 16817

4,083 0
Individuals or Households
   0 %

  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 4,083 0 0 -487 0 4,570
Annual IC Time Burden (Hours) 339 0 0 -40 0 379
Annual IC Cost Burden (Dollars) 2,001 0 0 -10 0 2,011

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