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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:
1240-0013
ICR Reference No:
201302-1240-001
Status:
Historical Active
Previous ICR Reference No:
201004-1240-013
Agency/Subagency:
DOL/OWCP
Agency Tracking No:
Title:
Claim for Compensation by a Dependent Information Reports
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:
08/19/2013
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/01/2013
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2016
36 Months From Approved
08/31/2013
Responses
2,920
0
1,358
Time Burden (Hours)
1,571
0
870
Cost Burden (Dollars)
1,431
0
638
Abstract:
These reports request information from the survivors of deceased Federal employees which verify dependents status when making a claim for benefits and on a periodic basis in accepted claims. Some of the forms are used to obtain information on claimed dependents in disability cases.
Authorizing Statute(s):
US Code:
5 USC 8101 et seq.
Name of Law: Augmented Compensation for Dependents
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:
78 FR 15742
03/12/2013
30-day Notice:
Federal Register Citation:
Citation Date:
78 FR 39014
06/28/2013
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
Claim for Compensation by a Dependent Information Reports
CA-5, CA-1074, CA-5B, CA-1031
Claim for Compensaion by Widow, Widower, and/or Children
,
Claimant Support of Dependent
,
Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandshildren
,
Request for Clarification of CA-5b
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
2,920
1,358
0
0
1,562
0
Annual Time Burden (Hours)
1,571
870
0
0
701
0
Annual Cost Burden (Dollars)
1,431
638
0
0
793
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:
The estimated number of annual respondents (2,920) is an increase of 1,562 from the previous request of 1,358. The estimate in burden hours (1,571) is an increase of (701) from the previously approved 870. Additionally, the estimated cost burden of $1,431 is $793 more than the previously requested of $638. The adjustment in the number of respondents and the burden hours are due in part to having a better accountability of tracking receipt of responses via a computer data base and in particular, with an emphasis in our program to send out letters to a claimant's estate to reclaim compensation in the event of death, i.e., the Comp Death Due letters. Further, costs burden has increased as a result of the respondents previously indicated and the fact that mailing costs is now 49 cents versus the previously requested of 47 cents. As a result of the Department of Treasury now requiring all federal benefits payments to be made electronically, the CA-5 and CA-5b were revised to include space on the forms for claimants to complete information related to direct deposit. The instructions to these forms regarding this requirement were also added. Additionally, all of the form letters/forms were revised to include an accommodation statement to inform claimants who have mental or physical limitations to contact DFEC if further assistance is needed with the claims process. This language is placed beneath the Public Burden Statement on the CA-5 and 5b, and as a footer on the remaining form letters.
Annual Cost to Federal Government:
$30,351
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:
07/01/2013
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