These reports request information from
the survivors of deceased Federal employees which verify dependents
status when making a claim for benefits and on a periodic basis in
accepted claims. Some of the forms are used to obtain information
on claimed dependents in disability cases.
US Code:
5 USC 8101 et seq. Name of Law: Augmented Compensation for
Dependents
The estimated number of annual
respondents (2,920) is an increase of 1,562 from the previous
request of 1,358. The estimate in burden hours (1,571) is an
increase of (701) from the previously approved 870. Additionally,
the estimated cost burden of $1,431 is $793 more than the
previously requested of $638. The adjustment in the number of
respondents and the burden hours are due in part to having a better
accountability of tracking receipt of responses via a computer data
base and in particular, with an emphasis in our program to send out
letters to a claimant's estate to reclaim compensation in the event
of death, i.e., the Comp Death Due letters. Further, costs burden
has increased as a result of the respondents previously indicated
and the fact that mailing costs is now 49 cents versus the
previously requested of 47 cents. As a result of the Department of
Treasury now requiring all federal benefits payments to be made
electronically, the CA-5 and CA-5b were revised to include space on
the forms for claimants to complete information related to direct
deposit. The instructions to these forms regarding this requirement
were also added. Additionally, all of the form letters/forms were
revised to include an accommodation statement to inform claimants
who have mental or physical limitations to contact DFEC if further
assistance is needed with the claims process. This language is
placed beneath the Public Burden Statement on the CA-5 and 5b, and
as a footer on the remaining form letters.
$30,351
No
No
No
No
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.
Form CA-5 Claim for Compensation by a Dependent Information Reports
Section 8110.doc
Salary Table 1240-0013.pdf
Claim for Compensation by a Dependent Information Reports