Information Collection Request
Request for State or Federal Workers' Compensation Information
ICR 202304-1240-008 · OMB 1240-0032 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1240-0032 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CM-905 Request for State or Federal Workers' Compensation Information |
Form | Modified | Repair queued |
 1240-0032 Supporting Statement (CM-905) 5-18-23.docx |
Supporting Statement A | Uploaded 2023-05-18 | Repair queued |
 System of Record Notice-DOL OWCP-2.pdf |
Supplementary Document | Uploaded 2019-11-14 | Missing upstream |
| 20 CFR 725 535.pdf |
Supplementary Document | Uploaded 2013-06-25 | Repair queued |
| 30 USC 924.pdf |
Supplementary Document | Uploaded 2013-06-25 | Missing upstream |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 13703 |  Request for State or Federal Workers' Compensation Information |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOL/OWCP |
| OMB Control No | 1240-0032 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202008-1240-045 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |