View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1240-0044	ICR Reference No: 201601-1240-009
Status: Historical Active	Previous ICR Reference No: 201506-1240-014
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Health Insurance Claim Form
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: 05/17/2016
	Date Received in OIRA: 01/29/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2019	36 Months From Approved	05/31/2016
Responses	2,777,034	0	3,036,067
Time Burden (Hours)	280,856	0	322,838
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	2,777,034	3,036,067	-259,033
Annual Time Burden (Hours)	280,856	322,838	-41,982
Annual Cost Burden (Dollars)	0	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: No

Burden Reduction Due to:

Short Statement: As the number of electronically submitted responses increase, the number of burden hours decreases. Electronically submitted responses require 1/10 of the burden hours than a manually submitted response. As a result, there is a net adjustment decrease of 41,982 hours (322,838 – 280,856 = 41,982).

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