OMB control number
Statement of Recovery Forms
OMB 1240-0001 · DOL/OWCP.
OMB 1240-0001
These OWCP forms are used to obtain information about amounts received as the result of final judgments in litigation, or a settlement of the litigation, brought against a third party who is liable for damages due to a Federal employee comprehensive work-related injury.
The latest form for Statement of Recovery Forms expires 2027-12-31 and can be found here.
Latest Forms, Documents, and Supporting Material
Document Name |
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Form and Instruction |
Form and Instruction |
Supporting Statement A |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Form CA-1122 Statement of Recovery
Supporting Statement 1240-0001_Final.docx
Statement of Recovery All Historical Document Collections
| Extension without change of a currently approved collection | 2024-11-21 | ||
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2024-04-24 | |
|
Approved without change |
Extension without change of a currently approved collection | 2022-01-11 | |
|
Approved without change |
Revision of a currently approved collection | 2018-11-30 | |
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2016-09-12 | |
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Approved without change |
Revision of a currently approved collection | 2015-08-07 | |
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Approved without change |
Revision of a currently approved collection | 2012-05-11 | |
|
Approved without change |
Extension without change of a currently approved collection | 2010-03-12 |
OMB Details
Statement of Recovery Forms
Federal Enterprise Architecture: Workforce Management - Labor Rights Management
| Form CA-1108 | Statement of Recovery | www.dol.gov/agencies/owcp/FECA/regs/compliance/forms | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.