Overpayment Recovery Questionnaire

ICR 200608-1215-001

OMB: 1215-0144

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2006-08-04
IC Document Collections
IC ID
Document
Title
Status
38463 Modified
ICR Details
1215-0144 200608-1215-001
Historical Active 200506-1215-010
DOL/ESA
Overpayment Recovery Questionnaire
Extension without change of a currently approved collection   No
Regular
Approved without change 10/16/2006
Retrieve Notice of Action (NOA) 08/11/2006
  Inventory as of this Action Requested Previously Approved
10/31/2009 36 Months From Approved 11/30/2006
4,020 0 4,520
4,020 0 4,520
1,768 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.

US Code: 5 USC 923(b) Name of Law: Federal Coal Mine Health and Safety Act of 1969
  
None

Not associated with rulemaking

  71 FR 29985 05/24/2006
71 FR 155 08/11/2006
No

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

  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 4,020 4,520 0 0 -500 0
Annual Time Burden (Hours) 4,020 4,520 0 0 -500 0
Annual Cost Burden (Dollars) 1,768 2,000 0 0 -232 0
No
No
There has been a reduction of 500 burden hours from 4,520 to 4,020 which is an adjustment of hours because benefit checks were issued after a beneficiary's death prior to notification of the death overpayments, repayment of the debt is not the burden of the person that received a descendant's benefits. The burden is on the bank that improperly failed to close the account and paid out the money. Rather than using the OWCP-20 form that a claimant debtor would complete, these overpayments are recovered using a protected need-to-know Department of Treasury website service to collect from the liable bank.

$131,331
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Mark Bedont 202 693-0815 bedont.mark@dol.gov

  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.
08/11/2006


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