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View ICR - OIRA Conclusion

OMB Control No: 1240-0017	ICR Reference No: 201908-1240-001
Status: Historical Active	Previous ICR Reference No: 201603-1240-001
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Death Gratuity
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/14/2020
	Date Received in OIRA: 04/14/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2023	36 Months From Approved
Responses	4	0	0
Time Burden (Hours)	1	0	0
Cost Burden (Dollars)	1	0	0

Abstract: The National Defense Authorization Act for Fiscal Year 2008, Public Law 110-181, was enacted on January 28, 2008. Section 1105 of P.L. 110-181 amended the Federal Employees' Compensation Act (FECA) creating a new section, 5 U.S.C. § 8102a effective upon enactment. This section establishes a FECA death gratuity benefit of up to $100,000 for eligible beneficiaries of federal employees and Non-Appropriated Fund Instrumentality (NAFI) employees who die from injuries incurred in connection with service with an Armed Force in a contingency operation. 5 U.S.C.§ 8102a also permits agencies to authorize retroactive payment of the death gratuity for employees who died on or after October 7, 2001 in service with an Armed Force in the theater of operations of Operation Enduring Freedom and Operation Iraqi Freedom. 5 U.S.C. § 8102a also allows federal employees to vary the order of precedence of beneficiaries or to name alternate beneficiaries 20 CFR 10.909, and 10.911 provides that the CA-40, CA-41, and CA-42 are the forms to be used to designate beneficiaries and initiate the payment process for death gratuity benefits. Form CA-40 is an optional form that requests the information necessary from the employee to accomplish this variance and to name alternate beneficiaries only if the employee wishes to do so. Form CA-41 provides the means for those named beneficiaries and possible recipients to file claims for those benefits and requests information from such claimants so that OWCP may determine their eligibility for payment. Further, the statute and regulations require agencies to notify OWCP immediately upon the death of a covered employee. CA-42 provides the means to accomplish this notification and requests information necessary to administer any claim for benefits resulting from such a death.

Authorizing Statute(s): US Code: 5 USC 8102a Name of Law: Amendment to the FECA, Death Gratuity
   PL: Pub.L. 112 - 81 1121 Name of Law: National Defense Authorization Act for Fiscal Year 2012
   PL: Pub.L. 110 - 181 1105 Name of Law: National Defense Authorization Act for Fiscal Year 2008
   US Code: 5 USC 8145 Name of Law: Federal Employees' Compensation Act
   US Code: 5 USC 8149 Name of Law: Federal Employees' Compensation Act

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Approved	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	4	-258	262
Annual Time Burden (Hours)	1	-66	67
Annual Cost Burden (Dollars)	1	-2	3

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: This reinstatement is being made without a change to bring back into compliance as it has expired. The number of claims received for death gratuity has significantly decreased since the implementation of U.S.C. § 8102a in 2008. It is anticipated these claims will continually remain low since OWCP will pay death gratuity benefits minus the amount of any death gratuity payments that have been paid under any other law of the United States based on that same death. Only 1 agency report of death gratuity claim (CA-42) was received between 2016 and 2018, and there were two designated beneficiaries as noted on the CA-40. Both of these beneficiaries filed a CA-41 with OWCP. As a reminder, the CA-40 is an optional form, used only when an employee wishes to vary the order or preference or designate an alternate beneficiary for payment. Not all employees choose to fill out this form and submit it to their employing agency prior to deployment or may choose to rely on a designation from an earlier deployment. However, the completed CA-40 must be submitted to OWCP when a claim for death gratuity benefits is filed. Therefore, the previous approved number of annual respondents 262 is now 4, which represents a decrease in 258 respondents. The previously approved number for burden hours was 67; the requested number now is 1, which is a decrease of 66.

Annual Cost to Federal Government: $97

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? No

Agency Contact: Marcus Sharpless 202 693-0998 sharpless.marcus@dol.gov

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