View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 1240-0005	ICR Reference No: 202304-1240-005
Status: Active	Previous ICR Reference No: 202008-1240-059
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions
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 with change	Conclusion Date: 08/24/2023
	Date Received in OIRA: 06/28/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2026	36 Months From Approved	08/31/2023
Responses	705	0	695
Time Burden (Hours)	881	0	869
Cost Burden (Dollars)	409	0	12

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	705	695	10
Annual Time Burden (Hours)	881	869	12
Annual Cost Burden (Dollars)	409	12	397

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is an increase of 12 hours from previously established burden hours due to a slight increase in the number of authorized insurance carriers from the last submission which also subsequently increased responses and costs. Costs to respondents were erroneously recorded in the last iteration with an incorrect number and have increased.

Annual Cost to Federal Government: $18,358

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. No

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. No

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: Michelle Massenberg 202 354-9624 massenberg.michelle@dol.gov

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.