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OMB Control No:	ICR Reference No: 202405-1240-006
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Attending Physician’s Certification of Continuing Workers’ Compensation Disability
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 08/19/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	33,372	0
Time Burden (Hours)	2,670	0
Cost Burden (Dollars)	20,774	0

ICR Summary of Burden

	Total Request	Change Due to Agency Discretion
Annual Number of Responses	33,372	33,372
Annual Time Burden (Hours)	2,670	2,670
Annual Cost Burden (Dollars)	20,774	20,774

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: This is a new collection and therefore not yet on the OMB inventory.

Annual Cost to Federal Government: $169,437

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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