Information Collection Request

Request for State or Federal Workers' Compensation Information

ICR 202304-1240-008 · OMB 1240-0032 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1240-0032 can be found here:

Forms and Documents

Document Name	Status
Form CM-905 Request for State or Federal Workers' Compensation Information Form	Modified
1240-0032 Supporting Statement (CM-905) 5-18-23.docx Supporting Statement A	2023-05-18
System of Record Notice-DOL OWCP-2.pdf Supplementary Document	2019-11-14
20 CFR 725 535.pdf Supplementary Document	2013-06-25
30 USC 924.pdf Supplementary Document	2013-06-25

IC Document Collections

IC ID	Document Title	Status
13703	Request for State or Federal Workers' Compensation Information Form	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	DOL/OWCP
OMB Control No	1240-0032
Type of Information Collection	Extension without change of a currently approved collection
Previous ICR Reference No	202008-1240-045
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31