Claim for Reimbursement-Assisted Reemployment

Statement of Recovery Forms

Documents and Forms

Document Name Document Type
Form ca-1108 Claim for Reimbursement-Assisted Reemployment Form and Instruction
ca-1108 Statement of Recovery revised 1108 5-04-09[1][1].doc www/dol.gov/esa/owcp/regs/compliance/ca-1108.pdf Form and Instruction

Information Collection (IC) Details

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 and Instruction	ca-1108	Statement of Recovery	revised 1108 5-04-09[1][1].doc	http://www/dol.gov/esa/owcp/regs/compliance/ca-1108.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title: DOL/GOVT-1	FR Citation: 67 FR 16826

Number of Respondents: 25	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 Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	25	-2,675	-500	3,200
Annual IC Time Burden (Hours)	13	-1,337	-170	1,520
Annual IC Cost Burden (Dollars)	11	-1,204	215	1,000

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.