View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1240-0046	ICR Reference No: 202101-1240-003
Status: Historical Active	Previous ICR Reference No: 202008-1240-067
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Federal Employees' Compensation Act Medical Reports and Compensation Claims
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: 05/21/2021
	Date Received in OIRA: 02/24/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2024	36 Months From Approved	05/31/2021
Responses	282,353	0	282,353
Time Burden (Hours)	25,605	0	25,605
Cost Burden (Dollars)	122,824	0	110,118

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
FECA Medical Report Forms, Claim for Compensation	CA-1305, CA-1332, CA-1090, CA-1331 with CA-1087 enclosure, OWCP-5a, CA-20, owcp-5c, ca-16, owcp-5b, CA-7, CA-17	, , , , , , , , , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	282,353	282,353	0
Annual Time Burden (Hours)	25,605	25,605	0
Annual Cost Burden (Dollars)	122,824	110,118	12,706

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:

Annual Cost to Federal Government: $1,274,586

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

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