OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201008-1240-002 · OMB 1240-0016 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form ca-1032 Request for Information on Earnings, Dual Benefits, Dependents and Third Part Settlements Form Modified Available
summary of revisions to ca-1032-1.doc Supplementary Document Uploaded 2010-10-08 Available
Average hours and earnings of production and nonsupervisory employees(1) on private nonfarm payrolls by major industry sector,.txt Supplementary Document Uploaded 2010-08-30 Available
Salary Table 2010-RUS.htm Supplementary Document Uploaded 2010-08-30 Available
June 24, 2005 Final FECA Feasability Report - (CA-1032)[1].pdf Supplementary Document Uploaded 2010-08-30 Available
5 USC ACT Sections 8105, 8106, 8110, 8132, 8148[1].doc Supplementary Document Uploaded 2010-08-30 Available
20 CFR 10[1].528 for CA-1032.doc Supplementary Document Uploaded 2010-08-30 Available
DOL GOVT-1.doc Supplementary Document Uploaded 2010-08-30 Available
2010 Supporting Statment1240-0016(20110219).doc Supporting Statement A Uploaded 2011-02-19 Available
IC Document Collections
IC IDCollectionTypeStatusForm
13834 Request for Information on Earnings, Dual Benefits, Dependents and Third Part Settlements Form Modified
ICR Details
1240-0016 201008-1240-002
Historical Active 201003-1240-016
DOL/OWCP
Request for Information on Earnings, Dual Benefits, Dependents and Third Party Settlements
Revision of a currently approved collection   No
Regular
Approved without change 04/13/2011
Retrieve Notice of Action (NOA) 02/25/2011
  Inventory as of this Action Requested Previously Approved
04/30/2014 36 Months From Approved 04/30/2011
50,000 0 50,000
16,667 0 16,667
23,500 0 22,000
The 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 8101-8193 Name of Law: Federal Employees' Compensation Act
  
None
Not associated with rulemaking
  75 FR 63863 10/18/2010
76 FR 10625 02/25/2011
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 50,000 50,000 0 0 0 0
Annual Time Burden (Hours) 16,667 16,667 0 0 0 0
Annual Cost Burden (Dollars) 23,500 22,000 0 0 1,500 0
No
No
$437,625
No
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.
02/25/2011