View Information Collection Request (ICR) Package

OMB Control No: 1240-0009	ICR Reference No: 202005-1240-006
Status: Historical Active	Previous ICR Reference No: 201703-1240-006
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Notice of Recurrence
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: 01/22/2021
	Date Received in OIRA: 10/30/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2024	36 Months From Approved	01/31/2021
Responses	133	0	289
Time Burden (Hours)	67	0	145
Cost Burden (Dollars)	69	0	150

Abstract: This form is used by current, or occasionally former, Federal employees to claim wage loss or medical treatment resulting from a recurrence of a work-related injury while Federally employed. The information is necessary to ensure the accurate payment of benefits.

Authorizing Statute(s): US Code: 5 USC 8149 Name of Law: FederaL Employment Compensation Act-Regulations

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:
	85 FR 35955	06/12/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 68599	10/29/2020
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
Notice of Recurrence	CA-2a

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	133	289	-156
Annual Time Burden (Hours)	67	145	-78
Annual Cost Burden (Dollars)	69	150	-81

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 no change in reporting requirements. The adjustment for this submission is due to a decrease in the number of claims since the last approval. Over the last three fiscal years (FY2017-2019) an average of 2,654 recurrences were submitted. a decrease of 3,116 claims per year (5,770 was the average figure in the previous ICR submission in 2017). In applying the 5% rule described in the discussion in Question #1 above towards the number of claims being submitted by claimants who have left federal employment, the number of claims submitted by this group during this period is 133 (5% of 2,654) versus the previous OMB submission of 289 (5% of 5, 700). There is a decrease of 156 claims (289-133) since the last OMB submission. The annual Information Collection Time Burden is 67 hours which is a decrease of 78 hours based on the previous reporting hours of 145. The requested annual cost burden in dollars is $69 ($0.52 x 133). The prior cost burden was $150.00. There is a decrease of $81.00.

Annual Cost to Federal Government: $2,376

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: Anjanette Suggs 202 354-9660 suggs.anjanette@dol.gov

View ICR - OIRA Conclusion