View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1240-0022	ICR Reference No: 202208-1240-001
Status: Historical Active	Previous ICR Reference No: 201911-1240-006
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Notice of Law Enforcement Officer's Injury or Occupational Disease and Notice of Law Enforcement Officer's Death
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/07/2022
	Date Received in OIRA: 08/04/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2023	10/31/2023	10/31/2023
Responses	6	0	6
Time Burden (Hours)	6	0	6
Cost Burden (Dollars)	4	0	4

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	6	6
Annual Time Burden (Hours)	6	6
Annual Cost Burden (Dollars)	4	4

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: The previous approved number of annual respondents (7) is now 6, which represents a decrease of 1. The previously approved number for burden hours was 9, and the requested number now is 6, a decrease of 3. All of the initial claims submitted for calendar years 2016-2018 were for claimed injuries or occupational diseases. The decrease in annual respondents is because no death claims were created for calendar years 2016-2018.

Annual Cost to Federal Government: $101

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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