Certification of Funeral Expenses

Certification of Funeral Expenses

OMB: 1215-0027

IC ID: 13646

Information Collection (IC) Details

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Certification of Funeral Expenses
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 702.121

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form LS-265 Certification of Funeral Expenses ls-265.pdf http://www.dol.gov/esa/owcp/dlhwc/ls-265.pdf Yes No Fillable Printable

Workforce Management Worker Safety

DOL/GOVT-15  58 FR 49599

195 0
   
Private Sector Businesses or other for-profits
 
   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 195 0 0 0 0 195
Annual IC Time Burden (Hours) 49 0 0 0 0 49
Annual IC Cost Burden (Dollars) 86 0 0 86 0 0

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