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View ICR - OIRA Conclusion

OMB Control No: 1240-0029	ICR Reference No: 201003-1240-029
Status: Historical Active	Previous ICR Reference No: 200505-1215-002
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Request for Examination and/or Treatment
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/12/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/12/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2011	36 Months From Approved
Responses	75,000	0	101,250
Time Burden (Hours)	81,000	0	109,350
Cost Burden (Dollars)	3,558,000	0	41,000

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	75,000	101,250	-26,250
Annual Time Burden (Hours)	81,000	109,350	-28,350
Annual Cost Burden (Dollars)	3,558,000	41,000	3,517,000

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: No

Burden Reduction Due to:

Short Statement: Burden has been reduced by 28,350 hours (109,350 previous burden hours 81,000 current burden hours = 28,350 hours). This reduction in burden hours is the result of reduced reporting under the Act resulting in a reduction in the number of responses from the previous estimate of 101,250 responses to the current estimate of 75,000. A cost to the employer of $47.00 is applied per response for the physicians time in performing each exam and completing the form. This cost, which was not accounted for in the last submission, has increased the cost burden by $3,525,000. Netted against a reduction in mailing cost of $8,000 due to fewer responses, the cost burden has increased by $3,517,000.