Report of Accidental Injury in Support of Claim for Compensation or Pension/Statement of Witness to Accident (21P-4176)

OMB 2900-0104

OMB 2900-0104
Latest Forms, Documents, and Supporting Material
Document
Name
Form
Supplementary Document
Supplementary Document
Supporting Statement A
All Historical Document Collections
Approved without change
 Revision of a currently approved collection 2014-12-02
Approved without change
 Extension without change of a currently approved collection 2011-12-22
Approved without change
 Extension without change of a currently approved collection 2008-11-25
Approved without change
 Extension without change of a currently approved collection 2006-03-08
Approved without change
 Revision of a currently approved collection 2003-04-02
Withdrawn and continue
 Extension without change of a currently approved collection 2002-11-08
Approved without change
 Reinstatement without change of a previously approved collection 2000-03-06
Approved without change
 Extension without change of a currently approved collection 1996-11-05
Approved without change
 Revision of a currently approved collection 1993-11-19
Approved without change
 Extension without change of a currently approved collection 1990-10-01
Approved without change
 Extension without change of a currently approved collection 1987-09-24
Approved without change
 Reinstatement with change of a previously approved collection 1984-09-28
Approved without change
 Extension without change of a currently approved collection 1981-07-01
Approved with change
 No material or nonsubstantive change to a currently approved collection 1980-11-06
Approved without change
 Revision of a currently approved collection 1976-09-07
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