Information Collection

Statement of Recovery Forms

IC 13938 under ICR 202409-1240-003 · OMB 1240-0001.

Documents and Forms

Document Name Document Type
Form CA-1108 Statement of Recovery Forms Form and Instruction
CA-1108 Statement of Recovery CA-1108.pdf www.dol.gov/agencies/owcp/FECA/regs/compliance/forms Form and Instruction
CA-1108 Statement of Recovery CA-1108.pdf www.dol.gov/agencies/owcp/FECA/regs/compliance/forms 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.pdf	https://www.dol.gov/agencies/owcp/FECA/regs/compliance/forms	Yes	Yes	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title: DOL/GOVT-1	FR Citation: 81 FR 47418

Number of Respondents: 1,114	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 97 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,114	-40	1,154
Annual IC Time Burden (Hours)	557	-20	577
Annual IC Cost Burden (Dollars)	20	-1	21

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.