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OMB Control No: 1240-0032	ICR Reference No: 202601-1240-005
Status: Received in OIRA	Previous ICR Reference No: 202304-1240-008
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Request for State or Federal Workers' Compensation Information
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 03/11/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2026
Responses	3,980	4,155
Time Burden (Hours)	995	1,039
Cost Burden (Dollars)	2,973	2,356

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	3,980	4,155	-175
Annual Time Burden (Hours)	995	1,039	-44
Annual Cost Burden (Dollars)	2,973	2,356	617

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: Respondents: The number of respondents decreased from 4,155 to 3,980. The number of respondents decreased due to a decrease in forms processed. The following also decreased due to a decrease in number of forms received/responses. Responses: Responses have decreased from 4,155 to 3,980. Burden Hours: Burden hours have decreased from 1,039 to 995. Costs: Annual burden costs have increased from $2,356 to $2,973 due to postage rate increase.

Annual Cost to Federal Government: $52,238

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: Marcela Meneses 304 420-1232 meneses.marcela@dol.gov

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