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
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.