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View ICR - OIRA Conclusion

OMB Control No: 1240-0008	ICR Reference No: 202403-1240-001
Status: Active	Previous ICR Reference No: 202102-1240-006
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Rehabilitation Action Report
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: 04/26/2024
	Date Received in OIRA: 03/26/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2027	36 Months From Approved	05/31/2024
Responses	6,136	0	3,299
Time Burden (Hours)	1,043	0	550
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	6,136	3,299	2,837
Annual Time Burden (Hours)	1,043	550	493
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: As indicated in item 12, since the last clearance three years ago, the responses from the respondents increased from 3, 299 to 6,136, which is an adjustment upward of 2,837 responses. Accordingly, the burden hours increased from 550 to 1,043, an adjustment of 473 hours. We attribute the increase due to the increase in the number of claims filed since the last submission, as well as procedural adjustments in the usage of the form which has resulted in an uptick. The agency believes this most recent data accurately reflects the actual average number of responses and has made a corresponding change to the estimates.

Annual Cost to Federal Government: $95,286

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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