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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 13697 under ICR 202401-1240-003 · OMB 1240-0033.

Documents and Forms
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Information Collection (IC) Details

View Information Collection (IC)

Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim
 
No Modified
 
Mandatory
 
20 CFR 725.412a 20 CFR 725.408(a)(2)

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 Form.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable
Form CM-2970a OPERATOR RESPONSE TO NOTICE OF CLAIM CM-2970a Form.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable

Income Security General Retirement and Disability

DOL/OWCP-2 and DOL/OWCP-9  81 FR 25858

5,294 4,900
   
Private Sector Businesses or other for-profits
 
   70 %

  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 5,294 0 0 0 0 5,294
Annual IC Time Burden (Hours) 1,173 0 0 0 0 1,173
Annual IC Cost Burden (Dollars) 1,096 0 0 0 0 1,096

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.