Request for Information on Earnings, Dual Benefits, Dependents, and Third Party Settlements

ICR 202306-1240-003

OMB: 1240-0016

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2023-09-12
Supplementary Document
2023-09-12
Supplementary Document
2023-07-21
Supplementary Document
2023-07-21
Supplementary Document
2023-07-21
Supplementary Document
2023-06-30
Supplementary Document
2023-04-26
Supplementary Document
2023-04-26
Supplementary Document
2023-04-26
Supplementary Document
2023-04-26
Supplementary Document
2023-04-26
Supplementary Document
2023-04-26
Supplementary Document
2023-04-26
Supplementary Document
2023-04-26
Supporting Statement A
2023-09-19
ICR Details
1240-0016 202306-1240-003
Received in OIRA 202304-1240-010
DOL/OWCP
Request for Information on Earnings, Dual Benefits, Dependents, and Third Party Settlements
Extension without change of a currently approved collection   No
Regular 09/25/2023
  Requested Previously Approved
36 Months From Approved 11/30/2023
33,372 37,056
11,013 12,228
15,198 15,030

Form CA-1032 is used to obtain information from claimants receiving compensation for an extended period of time. This information is necessary to ensure that compensation being paid is correct.

US Code: 5 USC 8116 Name of Law: Federal Employees' Compensation Act
   US Code: 5 USC 8132 Name of Law: Federal Employees' Compensation Act
   US Code: 5 USC 8148 Name of Law: Federal Employees' Compensation Act
   US Code: 5 USC 8110 Name of Law: Federal Employees' Compensation Act
   US Code: 5 USC 8106 Name of Law: Federal Employees' Compensation Act
  
None

Not associated with rulemaking

  88 FR 37288 06/07/2023
88 FR 65755 09/25/2023
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 33,372 37,056 0 0 -3,684 0
Annual Time Burden (Hours) 11,013 12,228 0 0 -1,215 0
Annual Cost Burden (Dollars) 15,198 15,030 0 0 168 0
No
No
The previous approved number of annual respondents, 37,056 is now 33,372 which represents a decrease of 3,684. The previously approved number for burden hours was 12,228 the requested number now is 11,013, a decrease of 1,215 hours.

$416,449
No
    Yes
    Yes
No
No
No
No
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.
09/25/2023


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