View Information Collection Request (ICR) Package
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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:
1240-0058
ICR Reference No:
201910-1240-001
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
DOL/OWCP
Agency Tracking No:
Title:
Request for Intervention, Longshore and Harbor Workers' Compensation Act
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
03/03/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/25/2019
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
03/31/2023
36 Months From Approved
Responses
12,414
0
0
Time Burden (Hours)
3,191
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
Parties to LHWCA claims ask OWCP District Directors, who administer claims, to take a variety of routine actions, each depending on the claim. Currently, there is no uniform method for either requesting DD action or submitting the information necessary for the DD to evaluate the request. Parties submit the information in various formats. Capturing the required information in one form will save time, effort and cost for the federal government and simplify filing for the parties. The forms will also help OWCP properly classify different types of documents as it moves into a fully electronic case file environment and speed delivery of services to stakeholders.
Authorizing Statute(s):
US Code:
33 USC 939
Name of Law: Longshore and Harbor Workers' 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:
84 FR 38672
08/07/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 64106
11/20/2019
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 Intervention, Longshore and Harbor Workers' Compensation Act
LS-5, LS-8, LS-4, LS-6, LS-9, LS-7
Attorney Fee Approval Request
,
Aplication for Special Fund Relief
,
Request for Intervention
,
Settlement Approval Request Section 8(i)
,
Stipulation Approval Request
,
LS-6 Commutation Application
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
12,414
0
0
12,414
0
0
Annual Time Burden (Hours)
3,191
0
0
3,191
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Burden has been estimated by multiplying the estimated average response time with the estimated responses. The estimated responses were determined by a review of OWCP data maintained by the National Office, which reflect the number of requests made in FY2018, and the number of requests filed electronically. The response time is based on experience with the usual requests. The estimate takes into consideration that some cases require more information than others due to the complexity of the issues involved and the minute estimate should therefore be considered as an average time needed to gather the information, complete the form, obtain required signatures, and submit the required information.
Annual Cost to Federal Government:
$8,496
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:
Anjanette Suggs 202 354-9660 suggs.anjanette@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:
11/25/2019
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