Information Collection

Rehabilitation Maintenance Certificate

IC 43809 under ICR 202502-1240-004 · OMB 1240-0012.

Documents and Forms

Document Name Document Type
Form OWCP-17 Rehabilitation Maintenance Certificate Form
OWCP-17 Rehabilitation Maintenance Certificate owcp-17 with proposed changes.pdf www.dol.gov/owcp/dfec/regs/compliance/forms.htm Form
OWCP-17 Rehabilitation Maintenance Certificate owcp-17 with proposed changes.pdf www.dol.gov/owcp/dfec/regs/compliance/forms.htm Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rehabilitation Maintenance Certificate	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	OWCP-17	Rehabilitation Maintenance Certificate	owcp-17 with proposed changes.pdf	http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: DOL/GOVT-1 (FECA); DOL/OWCP-3; DOL/OWCP-4 (Longshore)	FR Citation: 81 FR 47418

Number of Respondents: 148	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,288	-2,164	3,452
Annual IC Time Burden (Hours)	215	-360	575
Annual IC Cost Burden (Dollars)	0	0	0

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.