SUMMARY OF REVISIONS
CA-2231
OMB NO: 1240-0018
In instructions, corrected item 16 to item 15. Deleted, “if item 5 does not apply to you, leave blank. Added, “If the claimant has not signed this form, please provide an explanation in the comments section”.
Block 5 –removed the requirement for the federal appropriations code. Replaced with employer’s Bill Payment Number.
Block 8—removed the requirement for the social security number and requires the claimant’s signature instead.
Block 10—removed Reporting Quarter.
Blocks 10 through 16 were renumbered 9 through 15, as a result of Block 10 deletion.
Added “to” , “from” and “hours” in block 9, now item 10, “Dates and Hours Worked
Added space for Supervisor to add comments, if form is unsigned by the claimant as per instructions.
Added a Privacy Act Statement.
| File Type | application/msword |
| File Title | SUMMARY OF REVISIONS |
| Author | US Department of Labor |
| Last Modified By | US Department of Labor |
| File Modified | 2010-05-13 |
| File Created | 2010-05-13 |