Overpayment Recovery Questionnaire

ICR 200506-1215-010

OMB: 1215-0144

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
38463 Migrated
ICR Details
1215-0144 200506-1215-010
Historical Active 200308-1215-001
DOL/ESA
Overpayment Recovery Questionnaire
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 06/29/2005
Retrieve Notice of Action (NOA) 06/29/2005
  Inventory as of this Action Requested Previously Approved
11/30/2006 11/30/2006 11/30/2006
4,520 0 4,500
4,520 0 4,500
2,000 0 2,000

Information collected with this form is used to evaluate the financial profile of OWCP beneficiaries who have been overpaid benefits, and their ability to repay. OWCP beneficiaries are typically retired coal miners disabled by black lung disease, Federal employees injured on the job, and their survivors.

None
None


No

1
IC Title Form No. Form Name
Overpayment Recovery Questionnaire OWCP-20

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,520 4,500 0 20 0 0
Annual Time Burden (Hours) 4,520 4,500 0 20 0 0
Annual Cost Burden (Dollars) 2,000 2,000 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/29/2005


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