OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act

ICR 201003-1240-006 · OMB 1240-0006 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form CA-278 Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act Form Modified Repair queued
DOL_GOVT-1.doc Supplementary Document Uploaded 2007-03-30 Available
SS for 1215-0202 CA-278 (January 2007).doc Supporting Statement A Uploaded 2007-03-30 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
13940 Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act Form Modified
ICR Details
1240-0006 201003-1240-006
Historical Active 200402-1215-001
DOL/OWCP
Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
Extension without change of a currently approved collection   No
Regular
Approved without change 03/12/2010
Retrieve Notice of Action (NOA) 03/12/2010
  Inventory as of this Action Requested Previously Approved
08/31/2010 36 Months From Approved
140 0 80
70 0 40
239 0 0
Information collected using Form CA-278 will allow OWCP to consider requests filed by insurance carriers and self-insured that have paid benefits to workers injured due to a war-risk hazard to be reimbursed for such benefits out of the Employees' Compensation Fund.
US Code: 42 USC 1701 Name of Law: War Hazards Compensation Act (WHCA)
   US Code: 5 USC 8147 Name of Law: The Federal Employees' Compensation Act
  
None
Not associated with rulemaking
  72 FR 1248 01/10/2007
72 FR 28552 05/21/2007
No
  Total Approved 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 140 80 0 0 60 0
Annual Time Burden (Hours) 70 40 0 0 30 0
Annual Cost Burden (Dollars) 239 0 0 0 239 0
No
No
The has been an adjustment of 40 burden hours to 70 burden hours which is an increae of 30 burden hours as a result of the number of claims being submitted due to the conflict in Iraq. There has been a change in the operation and maintenance cost due to an increase in postage from $97.00 to $239.00.
$62,053
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Macaire Carroll-Gavula 202 693-0819 [email protected]
  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.
05/22/2007