Information Collection

Statement of Recovery Forms

IC 13938 under ICR 201202-1240-002 · OMB 1240-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0001 can be found here:

Documents and Forms

Document Name Document Type
Form ca-1108 Statement of Recovery Forms Form and Instruction
ca-1108 Statement of Recovery CA-1108 final with accomodation statement-mjs-4-20-2012.pdf www.dol.gov/owcp/dfec/regs/compliance/forms.htm Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement of Recovery Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ca-1108	Statement of Recovery	CA-1108 final with accomodation statement-mjs-4-20-2012.pdf	http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title: DOL/GOVT-1	FR Citation: 67 FR 16826

Number of Respondents: 2,549	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,549	-151	2,700
Annual IC Time Burden (Hours)	1,275	-75	1,350
Annual IC Cost Burden (Dollars)	1,224	9	1,215

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.