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Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201701-1240-003 · 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
Privacy Act Systems - DOL-GOVT-1_mht.htm Supplementary Document Uploaded 2017-01-18 Available
OPM Salary Table.pdf Supplementary Document Uploaded 2017-01-18 Repair queued
Employment Earnings Table.docx Supplementary Document Uploaded 2017-01-18 Repair queued
5 USC Sections 8105, 8106, 8110, 8132 and 8148.doc Supplementary Document Uploaded 2017-01-18 Repair queued
20 cfr 10.528.doc Supplementary Document Uploaded 2017-01-18 Available
June 24, 2005 Final FECA Feasability Report - (CA-1032).pdf Supplementary Document Uploaded 2017-01-18 Available
Supporting Statement 1240-0016 2017.doc Supporting Statement A Uploaded 2017-02-28 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 201701-1240-003
Historical Active 201310-1240-001
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 08/16/2017
Retrieve Notice of Action (NOA) 05/31/2017
  Inventory as of this Action Requested Previously Approved
08/31/2020 36 Months From Approved 08/31/2017
45,161 0 44,800
15,054 0 14,933
5,166 0 23,296
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 8101-8193 Name of Law: Federal Employees' Compensation Act
  
None
Not associated with rulemaking
  82 FR 11946 02/27/2017
82 FR 23608 05/23/2017
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 45,161 44,800 0 0 361 0
Annual Time Burden (Hours) 15,054 14,933 0 0 121 0
Annual Cost Burden (Dollars) 5,166 23,296 0 0 -18,130 0
No
No
The previous approved number of annual respondents, 44,800 is now 45,161, which represents an increase of 361. The previously approved number for burden hours was 14,933 and the requested number now is 15,054, an increase of 121 hours. The annual cost burden is now estimated at $5,166, which is a decrease from the previously approved burden estimate of $23,296, which is an adjustment of $18,130.
$437,272
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.
05/31/2017