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View ICR - OIRA Conclusion

OMB Control No: 1240-0001	ICR Reference No: 201808-1240-001
Status: Historical Active	Previous ICR Reference No: 201609-1240-002
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Statement of Recovery Forms
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: 02/14/2019
	Date Received in OIRA: 11/30/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	36 Months From Approved	02/28/2019
Responses	938	0	842
Time Burden (Hours)	467	0	419
Cost Burden (Dollars)	249	0	219

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	938	842	96
Annual Time Burden (Hours)	467	419	48
Annual Cost Burden (Dollars)	249	219	30

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 previously approved number of annual responses, 842, is being increased to 938, which represents an increase of 96. The adjustments in burden hours are due to an increase in the number of third-party claims. The currently approved number of hours is 419 and the requested number of hours is 467, an increase of 48. Likewise, costs burden is now estimated at $249 versus the previously approved $219 which represents an increase of $30.00. The increase in these numbers represent a fluctuation in the number of annual respondents.

Annual Cost to Federal Government: $16,007

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

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

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