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View ICR - OIRA Conclusion

OMB Control No: 1240-0045	ICR Reference No: 202311-1240-001
Status: Active	Previous ICR Reference No: 202008-1240-056
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Rehabilitation Plan and Award
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: 01/10/2024
	Date Received in OIRA: 12/08/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2027	36 Months From Approved	01/31/2024
Responses	3,413	0	3,176
Time Burden (Hours)	1,707	0	1,588
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	3,413	3,176	237
Annual Time Burden (Hours)	1,707	1,588	119
Annual Cost Burden (Dollars)	0	0	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: Over the last 3 fiscal years (FY2020 to 2022), open rehabilitation cases have averaged 3,413, which is an increase of 237 from the previous request of 3,176. This slight increase may be attributed to normal variation of programmatic referral numbers as well as an increase in Claims staff who make the referrals. As previously indicated in item 12, there are no costs for burden hours as the respondents submit the form electronically.

Annual Cost to Federal Government: $95,221

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: Pamela Hamai 415 241-3350 hamai.pamela@dol.gov

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