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Claim for Reimbursement-Assisted Reemployment
Claim for Reimbursement-Assisted Reemployment
OMB: 1215-0178
IC ID: 13892
OMB.report
DOL/ESA
OMB 1215-0178
ICR 200611-1215-002
IC 13892
( )
Documents and Forms
Document Name
Document Type
Form CA-2231
Claim for Reimbursement-Assisted Reemployment
Form
CA-2231 Claim for Reimbursement Assisted Reemployment
ca-2231.pdf
www.dol.gov/esa/regs/compliance/owcp/ca-2231
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Claim for Reimbursement-Assisted Reemployment
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
CA-2231
Claim for Reimbursement Assisted Reemployment
ca-2231.pdf
http://www.dol.gov/esa/regs/compliance/owcp/ca-2231
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Labor Rights Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
20
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
80
0
0
0
0
80
Annual IC Time Burden (Hours)
40
0
0
0
0
40
Annual IC Cost Burden (Dollars)
34
0
0
34
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.
