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View ICR - OIRA Conclusion

OMB Control No: 1240-0001	ICR Reference No: 202109-1240-001
Status: Historical Active	Previous ICR Reference No: 201808-1240-001
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Statement of Recovery Forms
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: 02/17/2022
	Date Received in OIRA: 01/11/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2025	36 Months From Approved	02/28/2022
Responses	1,164	0	938
Time Burden (Hours)	580	0	467
Cost Burden (Dollars)	21	0	249

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	1,164	938	226
Annual Time Burden (Hours)	580	467	113
Annual Cost Burden (Dollars)	21	249	-228

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 has been an increase in the number of respondents, FY2018–FY2020, due to an increase in the number of third-party claims. Accordingly, the previously approved number of annual responses, 938 is being increased to 1,164, which represents a difference of 226. The adjustments in burden hours are due to the increase in the number of third-party claims. The currently approved number of hours is 467 and the requested number of hours is 580 , an increase of 113.

Annual Cost to Federal Government: $7,735

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: Marcus Sharpless 202 693-0998 sharpless.marcus@dol.gov

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