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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:
1240-0016
ICR Reference No:
201701-1240-003
Status:
Historical Active
Previous ICR Reference No:
201310-1240-001
Agency/Subagency:
DOL/OWCP
Agency Tracking No:
Title:
Request for Information on Earnings, Dual Benefits, Dependents, and Third Party Settlements
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:
08/16/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/31/2017
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2020
36 Months From Approved
08/31/2017
Responses
45,161
0
44,800
Time Burden (Hours)
15,054
0
14,933
Cost Burden (Dollars)
5,166
0
23,296
Abstract:
Form CA-1032 is used to obtain information from claimants receiving compensation for an extended period of time. This information is necessary to ensure that compensation being paid is correct.
Authorizing Statute(s):
US Code:
5 USC 8101-8193
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:
82 FR 11946
02/27/2017
30-day Notice:
Federal Register Citation:
Citation Date:
82 FR 23608
05/23/2017
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
Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements
CA-1032
Request for Information on Earnings, Dual Benefits, Dependents, and Third Party Settlement
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
45,161
44,800
0
0
361
0
Annual Time Burden (Hours)
15,054
14,933
0
0
121
0
Annual Cost Burden (Dollars)
5,166
23,296
0
0
-18,130
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, 44,800 is now 45,161, which represents an increase of 361. The previously approved number for burden hours was 14,933 and the requested number now is 15,054, an increase of 121 hours. The annual cost burden is now estimated at $5,166, which is a decrease from the previously approved burden estimate of $23,296, which is an adjustment of $18,130.
Annual Cost to Federal Government:
$437,272
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:
05/31/2017
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