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OMB Control No: 1215-0034	ICR Reference No: 200805-1215-007
Status: Historical Active	Previous ICR Reference No: 200510-1215-003
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: Agreement and Undertaking
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/28/2008
	Date Received in OIRA: 09/24/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2011	36 Months From Approved	12/31/2008
Responses	20	0	300
Time Burden (Hours)	5	0	75
Cost Burden (Dollars)	9	0	0

Abstract: The OWCP-1 is a form completed by employers to provide the Secretary of Labor with authorization to sell securities or to bring suit under indemnity bonds deposited by the self-insured employers in the event there is a default in the payment of benefits.

Authorizing Statute(s): US Code: 30 USC 933 Name of Law: Federal Coal Mine Health and Safety Act of 1969

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 31889	06/04/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 55134	09/24/2008
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Agreement and Undertaking	OWCP-1

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	20	300	-204	-76
Annual Time Burden (Hours)	5	75	-51	-19
Annual Cost Burden (Dollars)	9	0	9	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: The burden hours have been reduced from the previous submission of 75 hours to 5 hours. There has been a program change (-204 responses and -51 hours) due to a substantial reduction in burden hours and operation costs because of the discontinuance of this collection by the Division of Longshore and Harbor Workers' Compensation (DLHWC) (200 forms). DLHWC now uses forms LS-275ic and LS-275si, which together comprise OMB 1215-0204. There is an operation and maintenance cost of $9.00 for mailing for the 20 responses. In addition, use of the OWCP-1 by the Division of Coal Mine Workers' Compensation (DCMWC) is declining because of mergers and consolidation of coal mine operators in which a single operator self-insures a number of subsidiaries (an adjustment of -76 responses and -19 burden hours).

Annual Cost to Federal Government: $76

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Michael McClaran 202-693-0978 mcclaran.michael@dol.gov

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