These forms are used to obtain
information about amounts received as the result of final judgments
in litigation, or a settlement of the litigation, brought against a
third party who is liable for damages due to a Federal employee
comprehensive work-related injury.
US Code:
5 USC
8131 Name of Law: Federal Employees' Compensation Act
US Code: 5 USC
8132 Name of Law: Federal Employees' Compensation Act
The adjustments in the burden
hours are due to a decrease in the number of third party claims.
The previous approved number of annual responses, 3200, is being
reduced to 3,000, which represents a reduction of 200 respondents.
The approved number of hours is 1520 and the requested number of
hours is 1425,a decrease of 95. In addition, due to an increase in
postage, the maintenance and reporting costs have increased from
$1,000 to $1,350, which is an increase of $350.00.
$43,185
No
No
Uncollected
Uncollected
No
Uncollected
Marcus Sharpless 202 693-0998
sharpless.marcus@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.