OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Claim for Compensation by Dependents Information Reports

OMB 1215-0155 · DOL/ESA.

OMB 1215-0155

Latest Forms, Documents, and Supporting Material

Document Name
Form CA-1074 Claim for Compensation by Dependents Information Reports Form
DOL-GOVT-1.pdf Supplementary Document
27 CFR Chapter 10.7 thru 10.537.pdf Supplementary Document
Table B-3 Average Hourly and Weekly Earnings.pdf Supplementary Document
Salary Table 2006-RUS.pdf Supplementary Document
Section 8110 Augmented Compensation for Dependents.pdf Supplementary Document
SS 1215-0155 10.10.06.doc Supporting Statement A
Claim for Compensation by Dependents Information Reports Form

All Historical Document Collections

200610-1215-003 Approved without change	Extension without change of a currently approved collection	2007-03-01
200403-1215-002 Approved without change	Extension without change of a currently approved collection	2004-03-12
200102-1215-005 Approved without change	Extension without change of a currently approved collection	2001-02-22
199803-1215-001 Approved without change	Extension without change of a currently approved collection	1998-03-06
199501-1215-003 Approved without change	Extension without change of a currently approved collection	1995-01-31
199201-1215-002 Approved without change	Extension without change of a currently approved collection	1992-01-15
198901-1215-002 Approved without change	Revision of a currently approved collection	1989-01-25
198603-1215-005 Approved without change	Revision of a currently approved collection	1986-03-13
198403-1215-004 Approved without change	New collection (Request for a new OMB Control Number)	1984-03-12