OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202003-1240-006 · OMB 1240-0016 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form CA-1032 Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements Form and Instruction Modified Available
20 cfr 10.528.docx Supplementary Document Uploaded 2020-03-20 Available
DOL GOVT-1.docx Supplementary Document Uploaded 2020-03-20 Available
opm salary table 2020.pdf Supplementary Document Uploaded 2020-03-20 Available
Average hourly and weekly earnings of production and nonsupervisory employees on private nonfarm payrolls by industry sector, seasonally adjusted.docx Supplementary Document Uploaded 2020-03-20 Repair queued
5 USC Sections 8105, 8106, 8110, 8132 and 8148.docx Supplementary Document Uploaded 2020-03-20 Available
1240-0016 Supporting Statement final.docx Supporting Statement A Uploaded 2020-08-05 Available
IC Document Collections
IC IDCollectionTypeStatusForm
13834 Request for Information on Earnings, Dual Benefits, Dependents, and Third Part Settlements Form and Instruction Modified
ICR Details
1240-0016 202003-1240-006
Active 201701-1240-003
DOL/OWCP
Request for Information on Earnings, Dual Benefits, Dependents, and Third Party Settlements
Extension without change of a currently approved collection   No
Regular
Approved without change 11/23/2020
Retrieve Notice of Action (NOA) 08/19/2020
  Inventory as of this Action Requested Previously Approved
11/30/2023 36 Months From Approved 11/30/2020
37,056 0 45,161
12,352 0 15,054
15,030 0 5,166
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
  85 FR 18279 04/01/2020
85 FR 50838 08/18/2020
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 37,056 45,161 0 0 -8,105 0
Annual Time Burden (Hours) 12,352 15,054 0 0 -2,702 0
Annual Cost Burden (Dollars) 15,030 5,166 0 0 9,864 0
No
No
The previous approved number of annual respondents, 45, 161, 800 is now 37, 056, which represents a decrease of 8105. The previously approved number for burden hours was 15, 054 the requested number now is 12, 352, a decrease of 2, 702 hours.
$426,539
No
    Yes
    Yes
No
No
No
No
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.
08/19/2020