Information Collection

Operator Controversion, Operator Response, Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim

IC 13697 under ICR 201003-1240-033 · OMB 1240-0033.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0033 can be found here:

Documents and Forms

Document Name Document Type
Form CM-2970 Operator Controversion, Operator Response, Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim Form
CM-2970 Operator Response to Schedule for Submission of Addition CM-2970.pdf www.dol.gov/esa/regs/compliance/owcp/cm-2970.pdf Form
CM-2970A Operator Response to Notice of Claim CM-2970a.pdf www.dol.gov/esa/regs/compliance/owcp/cm-2970a.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Operator Controversion, Operator Response, Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 725.408 20 CFR 725.412

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CM-2970	Operator Response to Schedule for Submission of Additional Evidence	CM-2970.pdf	http://www.dol.gov/esa/regs/compliance/owcp/cm-2970.pdf	Yes	Yes	Fillable Fileable Signable
Form	CM-2970A	Operator Response to Notice of Claim	CM-2970a.pdf	http://www.dol.gov/esa/regs/compliance/owcp/cm-2970a.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/ESA-15	FR Citation: 58 FR 49559

Number of Respondents: 8,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	8,000	-200	0	8,200
Annual IC Time Burden (Hours)	2,333	-42	666	1,709
Annual IC Cost Burden (Dollars)	3,520	0	520	3,000

Documents for IC

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.