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View ICR - OIRA Conclusion

OMB Control No: 1240-0058	ICR Reference No: 202511-1240-001
Status: Active	Previous ICR Reference No: 202210-1240-001
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Request for Intervention, Longshore and Harbor Workers' Compensation Act
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: 04/10/2026
	Date Received in OIRA: 03/06/2026
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2029	36 Months From Approved	04/30/2026
Responses	21,176	0	12,414
Time Burden (Hours)	5,828	0	3,189
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	21,176	12,414	8,762
Annual Time Burden (Hours)	5,828	3,189	2,639
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: The number of respondents and responses both increased from 12,414 to 21,176 due to the increase in the number of forms received. The increase in number of respondents therefore resultingly increased the number of burden hours from 3,189 to 5,828. Costs to respondents remained the same at 0.

Annual Cost to Federal Government: $22,177

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: Anjanette Suggs 202 354-9660 suggs.anjanette@dol.gov

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