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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:
1240-0006
ICR Reference No:
201609-1240-003
Status:
Historical Active
Previous ICR Reference No:
201306-1240-002
Agency/Subagency:
DOL/OWCP
Agency Tracking No:
Title:
Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
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:
03/02/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/30/2016
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
03/31/2020
36 Months From Approved
03/31/2017
Responses
345
0
393
Time Burden (Hours)
173
0
197
Cost Burden (Dollars)
542
0
1,407
Abstract:
Information collected using Form CA-278 will allow OWCP to consider requests filed by insurance carriers and self-insured that have paid benefits to workers injured due to a war-risk hazard to be reimbursed for such benefits out of the Employees' Compensation Fund.
Authorizing Statute(s):
US Code:
5 USC 8147
Name of Law: The Federal Employees' Compensation Act
US Code:
42 USC 1701
Name of Law: War Hazards Compensation Act (WHCA)
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:
81 FR 70443
10/12/2016
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR 97112
12/30/2016
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 Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
CA-278
Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards 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
345
393
0
0
-48
0
Annual Time Burden (Hours)
173
197
0
0
-24
0
Annual Cost Burden (Dollars)
542
1,407
0
0
-865
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 previous approved number of annual respondents 393 is now 345, which represents a decrease of 48. The previously approved number for burden hours was 197, and the requested number now is 173, a decrease of 24.00. This decrease is a result of reduction in claims for reimbursement of benefit payments and claim expenses under the WHCA. The costs burden for maintenance and reporting costs postage and envelope) decreased from $1,407 to $542, which is an adjustment of $865.00. Revision to the forms solely involved the accommodation language. The following accommodation language was placed on the bottom of the form: 1. If you have a disability and are in need of communication assistance (such as alternate formats or sign language interpretation), accommodations and/or modifications, please contact OWCP. See instructions for additional details. 2. The accommodation language in the Instructions page was revised.
Annual Cost to Federal Government:
$8,453
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:
12/30/2016
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