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Voluntary Demographic Survey for Office of Workers' Compensation Programs (OWCP) Claimants

IC 263928 under ICR 202312-1240-002 · OMB 1240-0061.

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Voluntary Demographic Survey for Office of Workers' Compensation Programs (OWCP) Claimants
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CM-411 Voluntary Demographic Survey for Office of Workers’ Compensation Programs (OWCP) Claimants Voluntary Demographic Information Form Final BL_NMH.pdf https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable

Income Security General Retirement and Disability

DOL/OWCP-2  81 FR 25765

18,077 0
   
Individuals or Households
 
   30 %

  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 18,077 0 18,077 0 0 0
Annual IC Time Burden (Hours) 1,506 0 1,506 0 0 0
Annual IC Cost Burden (Dollars) 3,127 0 3,127 0 0 0

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