SS 1215-0178 October 20, 2006

SUPPORTING STATEMENT

CLAIM FOR REIMBURSEMENT-ASSISTED REEMPLOYMENT

FORM CA-2231

OMB NO. 1215-0178

1. The Office if Workers’ Compensation Programs (OWCP) administers the Federal Employees’ Compensation Act (FECA) (5 U.S.C. 8101 et seq., http://nt5.scbbs.com/cgi-bin/om_isapi.dll?clientID=296716&infobase=feca-act.nfo&softpage=PL_frame). Section 8104(a) of the FECA provides vocational rehabilitation services to eligible injured workers to facilitate their return to work. The costs of providing these vocational rehabilitation services are paid from the Employees’ Compensation Fund. Annual appropriations language (currently in Public Law 109-289, http://thomas.loc.gov/cgi-bin/query/C?c109:./temp/~c109xLAZap ) provides OWCP with legal authority to use amounts from the Fund to reimburse private sector employers for a portion of the salary of reemployed disabled Federal workers they have hired through OWCP’s assisted reemployment program.

2. Information collected on Form CA-2231 provides OWCP with the necessary remittance information for the employer, documents the hours of work, certifies the payment of wages to the claimant for which reimbursement is sought, and summarizes the nature and costs of the wage reimbursement program for a prompt decision by OWCP.

Failure to collect this information would prevent timely and accurate reimbursement to employers, hinder the documentation of disbursements from the Fund, and obstruct implementation of the assisted reemployment program.

3. Form CA-2231 is currently posted on the internet at http://www.dol.gov/esa/regs/compliance/owcp/ca-2231.pdf for downloading by private sector employers. The form may be electronically filled.

4. The information collected on this form is not duplicative of any information available elsewhere. The respondent is the only source of the data needed to process the reimbursement request.

5. This information collection does not have a significant economic impact on a substantial number of small entities.

6. Please refer to nos. 1 and 2 above. The information collected from private sector employers is the minimum needed to evaluate whether a reimbursement request meets the requirements of OWCP’s assisted reemployment program. Reimbursement requests cannot be processed by OWCP without the information collected.

7. There are no special circumstances for the collection of this information.

8. There have been no comments from employers regarding this form.

A notice inviting public comment on this information collection was published in the Federal Register on November 20, 2006. No comments were received.

9. No payments or gifts are provided to respondents.

10. All in formation collected by and submitted with Form CA-2231 is protected under the Privacy Act (http://www.usdoj.gov/foia/privstat.htm) in the system of records known as DOL/GOVT-1. (http://www.dol.gov/sol/privacy/dol-govt-1.htm)

11. There are no questions of a sensitive nature contained on the form.

12. According to the records maintained by OWCP, there are about 20 FECA claimants involved in the assisted reemployment program at any one time. The information is requested quarterly from each of the approximately 20 respondents. It is estimated that it will take ½ hour for a respondent to collect the information from its payroll records, fill in Form CA-2231, and return it to OWCP. The total annual hour burden, therefore, is estimated to be 40 hours (80 responses x 0.5 hours/response = 40 hours).

Using the current median hourly wage for payroll and timekeeping clerks (reported by the Bureau of Labor Statistics, http://www.bls.gov/oes/current/oes433051.htm ) of $15.08 per hour, the respondent annualized cost estimate for this collection is rounded to $603.00. ($15.08 X 40 hours = $603.20).

13. There are no capital/startup or ongoing operation/maintenance costs associated with this information collection. Operation and maintenance costs consist solely of mailing costs. An estimated annual total of 80 mailed responses at $0.42 per response (based on $0.39 for postage + $0.03 for an envelope) = annual operation and maintenance costs is rounded to $34.00 (80 x 0.42 = 33.60).

14. The estimated costs to the Federal government of collecting the information on Form CA-2231 are set out below:

Printing costs: Due to the small number of respondents that use Form CA-2231 to request reimbursement from OWCP, there are no plans to print the form in bulk for distribution.

Mailing/Developmental costs: Private sector employers who wish to request reimbursement under the assisted reemployment program can download Form CA-2231 directly from the internet and for that reason; no mailing costs for the form are incurred. There are also no developmental costs associated with this collection information.

Processing/Reviewing costs: Reimbursement requests are evaluated by OWCP Rehabilitation Specialists employed at the GS-12, step 6 level; it takes them an average of 10 minutes to review the form. Based on the estimated number of responses, the total time spent reviewing all 80 responses to Form CA-2231 is 800 minutes or 13 1/3 hours (800 minutes divided by 60 minutes/hour = 13.33 hours) annually. Using Salary Table 2006-RUS (http://opm.gov/oca/06tables/pdf/rus_h.pdf), it costs $464 ($34.82/hours at the GS 12, step 6 level x 13.33 hours = $464) to process 80 reimbursement requests.

The total estimated Federal cost of this collection is $464.

15. There are no changes in the burden hours for this submission.

16. There have no plans to publish any data collected by Form CA-2231.

17. The agency plans to display the expiration date for OMB approval of the information collection on all instruments.

18. There are no exceptions to the certification statement.

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