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: 1240-0029	ICR Reference No: 201403-1240-001
Status: Historical Active	Previous ICR Reference No: 201102-1240-002
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: 08/12/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/16/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2017	36 Months From Approved	08/31/2014
Responses	96,000	0	144,000
Time Burden (Hours)	52,000	0	78,000
Cost Burden (Dollars)	2,088,960	0	3,417,840

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	96,000	144,000	-48,000
Annual Time Burden (Hours)	52,000	78,000	-26,000
Annual Cost Burden (Dollars)	2,088,960	3,417,840	-1,328,880

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: There is a decrease of 26,000 burden hours since the last clearance submission due to a decrease in reporting under the Act. There has been a decrease in the operation and maintenance costs from $3,417,840 to $2,088,960 due to a decrease in reporting under the Act.