View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1240-0042	ICR Reference No: 202105-1240-002
Status: Historical Active	Previous ICR Reference No: 202008-1240-055
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Notice of Controversion of Right to Compensation
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/04/2021
	Date Received in OIRA: 07/01/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	36 Months From Approved	09/30/2021
Responses	19,250	0	18,000
Time Burden (Hours)	4,813	0	4,500
Cost Burden (Dollars)	2,118	0	296

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	19,250	18,000	0	1,250
Annual Time Burden (Hours)	4,813	4,500	0	313
Annual Cost Burden (Dollars)	2,118	296	1,822	0

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: Burden time and cost have increased due to an increase in the number of claims controverted and subsequent controversion forms filed. Burden cost has been reduced since forms can now be submitted electronically using our Secure Electronic Access Portal (SEAPortal), however, a miscalculation of the cost burden in the previous submission has resulted in an increase in cost burden showing in this submission.

Annual Cost to Federal Government: $64,803

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

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