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CHANGE WORKSHEET FOR OMB NO

ICR 201612-1240-009 · OMB 1240-0014 · Object 70393601.

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Status: The document is viewable, but some background extraction is still pending.

Queue: Repair is in progress, but the document is still incomplete and remains in the worker queue. (priority 70 · next 2026-05-14 14:30:43)

Missing: html

Download: Source copy (docx)

Primary: docxSource: application/vnd.openxmlformats-officedocument.wordprocessingml.document
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Document Metadata
File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleCHANGE WORKSHEET FOR OMB NO
AuthorUS Department of Labor
File Created2021-01-23
Conversion Statepartial