Claim for Continuance of Compensation

Claim for Continuance of Compensation (CA-12)

Documents and Forms

Document Name Document Type
Form CA-12 Claim for Continuance of Compensation Form and Instruction
CA-12 Claim for Continuance of Comp under the FECA (CA-12) ca-12.pdf www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-12.pdf Form and Instruction
CA-12 Claim for Continuance of Comp under the FECA (CA-12) ca-12.pdf www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-12.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Claim for Continuance of Compensation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 10.126

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CA-12	Claim for Continuance of Comp under the FECA (CA-12)	ca-12.pdf	https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-12.pdf	Yes	Yes	Printable Only

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records
Title: DOL/GOVT-1	FR Citation: 81 FR 47418

Number of Respondents: 2,894	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 22 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,894	28	2,866
Annual IC Time Burden (Hours)	241	2	239
Annual IC Cost Burden (Dollars)	1,550	-12	1,562

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.