Federal Employees' Compensation Act Medical Reports and Compensation Claims

ICR 202206-1240-002

OMB: 1240-0046

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2022-06-24
Supporting Statement A
2021-02-24
Supplementary Document
2021-02-22
Supplementary Document
2021-02-22
Supplementary Document
2021-02-22
Supplementary Document
2021-02-22
Supplementary Document
2014-06-26
IC Document Collections
ICR Details
1240-0046 202206-1240-002
Received in OIRA 202101-1240-003
DOL/OWCP
Federal Employees' Compensation Act Medical Reports and Compensation Claims
No material or nonsubstantive change to a currently approved collection   No
Regular 06/24/2022
  Requested Previously Approved
05/31/2024 05/31/2024
282,353 282,353
25,605 25,605
122,824 122,824

Requesting an update to form: On the top of the form there is a current reference which states the following, “ If instructions are separated from this form, refer to form information https://www.dol/owcp/dfec.” This link no longer exists, and should be changed to the following: “ https://www.dol.gov/agencies/owcp/FECA/regs/compliance/forms. With regards to the form itself, there are 2 minor changes. On the top of the form there is a current reference which states the following, “ If instructions are separated from this form, refer to form information https://www.dol/owcp/dfec.” This link no longer exists, and should be changed to the following: “ https://www.dol.gov/agencies/owcp/FECA/regs/compliance/formsUpdate to the address on form due to the consolidation of the Division of Federal Employees' Compensation (DFEC) and the Longshore and Harbor Worker's Compensation the new Division is now noted as OWCP Division of Federal Employees', Longshore and Harbor Workers' Compensation (DFELHWC). The address in item 11 should now be noted as Office of Workers' Compensation Programs, Division of Federal Employees', Longshore and Harbor Workers' Compensation, Federal Employees' Compensation Act, (OWCP/DFELHWC-FECA), PO Box 8311, London, KY 4072-8311.

US Code: 5 USC 8103 Name of Law: Federal Employees Compensation Act
   US Code: 5 USC 8149 Name of Law: Federal Employees Compensation Act
   US Code: 5 USC 8101 Name of Law: Federal Employees Compensation Act
   US Code: 5 USC 8102 Name of Law: Federal Employees Compensation Act
  
None

Not associated with rulemaking

  85 FR 72701 11/13/2020
86 FR 9953 02/17/2021
No

  Total Request 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 282,353 282,353 0 0 0 0
Annual Time Burden (Hours) 25,605 25,605 0 0 0 0
Annual Cost Burden (Dollars) 122,824 122,824 0 0 0 0
No
No

$1,274,586
No
    Yes
    Yes
No
No
No
No
Anjanette Suggs 202 354-9660 suggs.anjanette@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.
06/24/2022


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