Notice of Issuance of Insurance Policy

Notice of Issuance of Insurance Policy

OMB: 1240-0048

IC ID: 13700

Information Collection (IC) Details

View Information Collection (IC)

Notice of Issuance of Insurance Policy
 
No Modified
 
Mandatory
 
20 CFR 726.208 -.213 20 CFR 726.206

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CM-921 Instructions For Completion of Form CM-921 cm-921 Form.pdf https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable

Income Security Survivor Compensation

 

3,465 0
   
Private Sector Businesses or other for-profits
 
   100 %

  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 3,465 0 0 0 0 3,465
Annual IC Time Burden (Hours) 61 0 0 0 0 61
Annual IC Cost Burden (Dollars) 11 0 0 0 0 11

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