View Information Collection Request (ICR) Package
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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:
1240-0039
ICR Reference No:
201003-1240-039
Status:
Historical Active
Previous ICR Reference No:
200510-1215-003
Agency/Subagency:
DOL/OWCP
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:
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
10/31/2011
36 Months From Approved
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
Agreement and Undertaking
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
20
300
0
-204
-76
0
Annual Time Burden (Hours)
5
75
0
-51
-19
0
Annual Cost Burden (Dollars)
9
0
0
9
0
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
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:
09/24/2008
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