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Federal forms, ICRs, and supporting documents

Information Collection Request

Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation

ICR 202006-1230-001 · OMB 1230-0014 · Active

Forms and Documents
DocumentTypeStatusAvailability
Justification Statement for Non-substantive Change.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-07-17 Repair queued
RETAIN Statement A.docx Supporting Statement A Uploaded 2019-12-03 Repair queued
RETAIN Statement B.docx Supporting Statement B Uploaded 2019-04-04 Available
RTW Coordinator Data Collection Tool.docx Supplementary Document Uploaded 2019-04-02 Available
Appendix A Individual Level Data Collection Tool.xlsx Supplementary Document Uploaded 2019-04-02 Available
Appendix A Program Data Collection Tool.xlsx Supplementary Document Uploaded 2019-04-02 Available
Quarterly Progress Report Appendix A.docx Supplementary Document Uploaded 2019-04-02 Available
signed part B review ODEP RETAIN_03_27_2019.pdf Supplementary Document Uploaded 2019-04-01 Available
60-day FRN-RETAIN_2018-13437.pdf Supplementary Document Uploaded 2019-03-25 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
235436 Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation Other-Survey Modified
ICR Details
1230-0014 202006-1230-001
Active 201911-1230-001
DOL/ODEP
Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 07/27/2020
Retrieve Notice of Action (NOA) 07/17/2020
  Inventory as of this Action Requested Previously Approved
05/31/2022 05/31/2022 05/31/2022
5,333 0 5,333
1,778 0 1,778
146,817 0 146,817
The RETAIN Demonstration Projects are a collaborative effort led by the U.S. Department of Labor’s Office of Disability Employment Policy (ODEP) in partnership with DOL’s Employment and Training Administration (ETA) and the Social Security Administration (SSA). RETAIN—Retaining Employment and Talent after Injury/Illness Network—projects will test the impact of early intervention strategies that improve stay-at-work/return-to-work (SAW/RTW) outcomes of individuals who experience work disability while employed. “Work disability” is defined as an injury, illness, or medical condition that has the potential to inhibit or prevent continued employment or labor force participation. SAW/RTW programs succeed by returning injured or ill workers to productive work as soon as medically possible during their recovery process and by providing interim part-time or light-duty work and accommodations, as necessary. The RETAIN Demonstration Projects are modeled after promising programs operating in Washington state, including the Centers of Occupational Health and Education (COHE), the Early Return to Work (ERTW), and the Stay at Work programs. While these programs operate within the state’s workers’ compensation system and are available only to people experiencing work-related injuries or illnesses, the RETAIN Demonstration Projects provide opportunities to improve SAW/RTW outcomes for both occupational and non-occupational injuries and illnesses of people who are employed, or at a minimum in the labor force, when their injury or illness occurs.
PL: Pub.L. 115 - 245 79 Name of Law: Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019
  
None
Not associated with rulemaking
  83 FR 29137 06/21/2018
84 FR 14401 04/10/2019
No
1
IC Title Form No. Form Name
Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation Spanish version of Disclosure Form, RETAIN SSA Authorization of Disclosure Form RETAIN SSA Authorization of Disclosure Form ,   Spanish version of Disclosure Form
  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 5,333 5,333 0 0 0 0
Annual Time Burden (Hours) 1,778 1,778 0 0 0 0
Annual Cost Burden (Dollars) 146,817 146,817 0 0 0 0
No
No
$0
Yes Part B of Supporting Statement
    Yes
    Yes
No
No
No
No
David Rosenblum 202 693-7840 [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.
07/17/2020