| TITLE OF INFORMATION COLLECTION REQUEST |
OMB CONTROL NO. |
| Self-Certification Medical Statement |
0579-0337 |
| DATE PREPARED |
| October 6, 2020 |
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OPM PAY TABLE |
09/2019
Benefits account for 38% of employee costs
and wages account for the remaining 62%.
W = .62 x TC
TC = 1.6129 x W
FB = .38 x TC
TC = 2.6316 x FB
2.6316 x FB = TC = 1.6129 x W
FB = (1.6129 / 2.6316) x W
FB = .613 x W
Fringe Benefits = Wages x .613
FRINGE BENEFITS FACTOR |
OVERHEAD COST FACTOR |
TOTAL FEDERAL GOVERNMENT COSTS |
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(A) |
(B) |
(C) |
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2020-DCB |
0.613 |
0.139 |
$592 |
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| ACTIVITY DESCRIPTION (incl form number) |
TOTAL ANNUAL RESPONSES |
AVG TIME PER RESPONSES |
TOTAL HOURS PER YEAR |
SALARY |
TOTAL COSTS |
| GRADE |
WAGE (Step 4) |
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(D) |
(E) |
(F) |
(G) |
(H) |
(1+B+C) X F X H |
| Compliance Agreement (PPQ 519) |
3 |
1.250 |
4 |
12 |
45.51 |
$182 |
| Federal Certificate (PPQ 540) |
30 |
0.200 |
6 |
12 |
45.51 |
$273 |
| Limited Permit (PPQ 530) |
1 |
0.200 |
1 |
12 |
45.51 |
$46 |
| Appeal of Limited Permit or Certificate |
1 |
0.150 |
1 |
12 |
45.51 |
$46 |
| Appeal of Cancelled Compliance Agreement |
1 |
0.150 |
1 |
12 |
45.51 |
$46 |
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