Information Collection Request
Rehabilitation Maintenance Certificate
ICR 202502-1240-004 · OMB 1240-0012 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form OWCP-17 Rehabilitation Maintenance Certificate |
Form | Modified | Missing upstream |
 1240-0012 Supporting Statement 2025.docx |
Supporting Statement A | Uploaded 2025-03-21 | Repair queued |
 Rehabilitation Counselors Wages.pdf |
Supplementary Document | Uploaded 2025-02-18 | Missing upstream |
| Office of Workers' Compensation Programs Longshore and Harbor Workers' Compensation Act Case Files.docx |
Supplementary Document | Uploaded 2025-02-18 | Repair queued |
| Privacy Act Systems-FECA.docx |
Supplementary Document | Uploaded 2025-02-18 | Missing upstream |
| Office of Workers' Compensation Programs, Longshore and Harbor Worker's Compensation Act Special Fund System.docx |
Supplementary Document | Uploaded 2025-02-18 | Missing upstream |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 43809 |  Rehabilitation Maintenance Certificate |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOL/OWCP |
| OMB Control No | 1240-0012 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202110-1240-001 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |