View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1240-0036	ICR Reference No: 202005-1240-004
Status: Historical Active	Previous ICR Reference No: 201703-1240-001
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Longshore and Harbor Workers' Compensation Act Pre-Hearing Statement
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/21/2021
	Date Received in OIRA: 10/16/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2024	36 Months From Approved	01/31/2021
Responses	3,800	0	3,513
Time Burden (Hours)	646	0	586
Cost Burden (Dollars)	1,102	0	1,742

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	3,800	3,513	287
Annual Time Burden (Hours)	646	586	60
Annual Cost Burden (Dollars)	1,102	1,742	-640

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: There is an increase of 60 burden hours since the last clearance submission due to an increase in the actual number of forms received over the last year. There has been a decrease in the operation and maintenance cost from $$1,742.00 to $1,102.00 (-$640) due to the increase in usage of the form electronically.

Annual Cost to Federal Government: $15,182

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. No

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. 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? No

Agency Contact: Cheryl Jordan 202 693-0289 jordan.cheryl@dol.gov

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