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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:
1240-0015
ICR Reference No:
201011-1240-003
Status:
Historical Active
Previous ICR Reference No:
201003-1240-015
Agency/Subagency:
DOL/OWCP
Agency Tracking No:
Title:
Claim for Continuance of Compensation
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:
05/03/2011
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2014
36 Months From Approved
05/31/2011
Responses
4,570
0
4,850
Time Burden (Hours)
379
0
403
Cost Burden (Dollars)
2,011
0
1,988
Abstract:
This form is used to obtain information from eligible survivors receiving death benefits for an extended period of time. This information is necessary to ensure that compensation being paid is accurate.
Authorizing Statute(s):
US Code:
5 USC 8133
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:
75 FR 82075
12/29/2010
30-day Notice:
Federal Register Citation:
Citation Date:
76 FR 24913
05/03/2011
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
Claim for Continuance of Compensation
CA-12
Claim for Continuance of Compensation Under the Federal Employees' Compensation Act
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
4,570
4,850
0
0
-280
0
Annual Time Burden (Hours)
379
403
0
0
-24
0
Annual Cost Burden (Dollars)
2,011
1,988
0
0
23
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 the DOL has revised the form to collect Social Security Numbers and make a few formatting changes, those changes do not materially to affect the public burden estimates for responding to this information collection. There are currently 4,570 individuals receiving death benefits vs. 4,850 in the prior submission. There is an adjustment of -24 burden hours this submission, the reporting hours in the previous submission was 403, and has changed to 379 hours. The operation and maintenance cost has increased ($23.00) from $1988 to $2011 due to adjustment in postage cost from .41 to .44 cents to return completed forms. The adjustments described above are attributed to enhanced computer capabilities to track filing of these types of claims.
Annual Cost to Federal Government:
$14,667
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:
05/03/2011
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