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OMB Control No: 1240-0006	ICR Reference No: 202511-1240-002
Status: Received in OIRA	Previous ICR Reference No: 202303-1240-003
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: War Hazards Compensation Act Claims, Benefits, and Notices
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 03/17/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2026
Responses	2,528	1,264
Time Burden (Hours)	1,264	632
Cost Burden (Dollars)	5,840	2,427

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	2,528	1,264	1,264	0
Annual Time Burden (Hours)	1,264	632	632	0
Annual Cost Burden (Dollars)	5,840	2,427	0	3,413

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: Respondents: The number of respondents increased from 7 to 14. This increase in respondents is due to the new WH-1 form being added to this collection. Responses: The number of responses increased from 1,264 to 2,528 due to the new WH-1 form being added to this collection Burden Hours: The total number of burden hours increase from 632 hours to 1,264 hours also due to the new WH-1 form being added to this collection. Costs to Respondents or Recordkeepers: Item 13 costs for this submission increased from $2,427.00 to $5,840.00 due to an increase in the mailing cost for first class mail and the increase in hourly rate for insurance claims and policy processing clerks.

Annual Cost to Federal Government: $71,744

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

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