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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1240-0009
ICR Reference No:
201101-1240-001
Status:
Historical Active
Previous ICR Reference No:
201003-1240-009
Agency/Subagency:
DOL/OWCP
Agency Tracking No:
Title:
Notice of Recurrence
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:
06/01/2011
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/02/2011
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2014
36 Months From Approved
05/31/2011
Responses
314
0
680
Time Burden (Hours)
157
0
340
Cost Burden (Dollars)
148
0
299
Abstract:
This form is used by current, or occasionally former, Federal employees to claim wage loss or medical treatment resulting from a recurrence of a work-related injury while Federally employed. The information is necessary to ensure the accurate payment of benefits.
Authorizing Statute(s):
US Code:
5 USC 8101, et seq
Name of Law: Federal Employees' Compensation Act
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:
76 FR 10071
02/23/2011
30-day Notice:
Federal Register Citation:
Citation Date:
76 FR 24533
05/02/2011
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
Notice of Recurrence
CA-2a
Notice of Recurrence
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
314
680
0
0
-366
0
Annual Time Burden (Hours)
157
340
0
0
-183
0
Annual Cost Burden (Dollars)
148
299
0
0
-151
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:
No
Burden Reduction Due to:
Short Statement:
While Form CA-2a has been revised, those changes are not expected to have a material effect on the time and cost burdens for this information collection. There are currently 6273 recurrences being submitted, a decrease of 7323 claims. There is a decrease of 366 in the number of claims being submitted by claimants who have left federal employment (i.e., 5% of 6273 = 314 versus the last submission of 680 (5% of 13,596 = 680. This results in a burden hour reduction of 183 (366 x .50) in this submission. The reporting burden hours in the previous submission were 340 and have changed to 157. The operation and maintenance costs have decreased $151.00 due to a reduction in the filing of claims (.47 x 314 = 148) versus $299 (.44 x 680 = 299), from the previous submission. The noted decreases described above are attributed to enhanced computer capabilities to track recurrence claims.
Annual Cost to Federal Government:
$5,374
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]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Marcus Sharpless 202 693-0998 sharpless.marcus@dol.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
05/02/2011
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