OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Contractor Surveys under the Federal Employees’ Compensation Act

ICR 201005-1240-004 · OMB 1240-0052 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
amendment summary of changes.doc Supplementary Document Uploaded 2010-10-27 Available
VPAT_SurveyMonkey.pdf Supplementary Document Uploaded 2010-06-01 Available
revised supporting statement b- sep24 (2).doc Supporting Statement B Uploaded 2010-09-27 Available
final supporting statement 10-19 (3).doc Supporting Statement A Uploaded 2010-10-27 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
192950 Contractor-Rehabilitation Counselor Survey Other-survey New
192949 Contractor Survey-Field Nurse Survey Instruction New
192948 Contractor Survey-COP Nurse Other-survey New
ICR Details
1240-0052 201005-1240-004
Historical Active
DOL/OWCP
Contractor Surveys under the Federal Employees’ Compensation Act
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 11/05/2010
Retrieve Notice of Action (NOA) 10/04/2010
  Inventory as of this Action Requested Previously Approved
11/30/2013 36 Months From Approved
330 0 0
68 0 0
0 0 0
COP Nurses, Field Nurses, and Rehabilitation Counselors would respond to this information collection to provide input regarding program effectiveness that OWCP-DFEC would use as part of an impact evaluation assessing the quality and types of services being provided during the return to work period.
None
None
Not associated with rulemaking
  75 FR 34768 06/18/2010
75 FR 61177 10/04/2010
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 330 0 0 330 0 0
Annual Time Burden (Hours) 68 0 0 68 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
As part of its 2008 Performance Analysis Rating Tool (PART) evaluation by the Office of Management and Budget (OMB) of the FECA program, OMB directed DFEC to conduct an “Impact Evaluation” of program effectiveness. An impact evaluation measures the effectiveness of the program and the extent to which its goals were achieved. To comply with the OMB directive, DFEC designed a study to focus on the effectiveness of its Disability Management (DM) activities. DM consists of the delivery of services that include early intervention by nurses, coordination of medical care and management of the disability, and assistance with return to work, including vocational rehabilitation. DOL has awarded a contract for the evaluation. Objectives of the study include a mapping out of the DM conceptual framework, (including workflow, staff roles and responsibilities, and processes), measurement of performance results, and an assessment effective workings of DM procedures and the coordination and execution of roles of the Federal and contractor staff involved in DM.
$10,249
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Marcus Sharpless 202 693-0998 [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.
10/04/2010