OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Peace Corps Volunteer Authorization for Examination and/or Treatment

ICR 202405-1240-004 · OMB 1240-0059 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form CA-15 Peace Corps Volunteer Authorization for Examination and/or Treatment Form and Instruction Modified Repair queued
OMB 1240-0059 Peace Corps Supporting Statement 2025 Early Rev.docx Supporting Statement A Uploaded 2025-08-01 Repair queued
60 day FRN 1240-0059. published.pdf Supplementary Document Uploaded 2024-09-09 Repair queued
81 Fed. Reg 47418 (July 21, 2016).pdf Supplementary Document Uploaded 2022-12-23 Repair queued
Privacy Act Systems-FECA.docx Supplementary Document Uploaded 2022-12-23 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
236890 Peace Corps Volunteer Authorization for Examination and/or Treatment Form and Instruction Modified
ICR Details
1240-0059 202405-1240-004
Received in OIRA 202212-1240-002
DOL/OWCP
Peace Corps Volunteer Authorization for Examination and/or Treatment
Revision of a currently approved collection   No
Regular 08/06/2025
  Requested Previously Approved
36 Months From Approved 02/28/2026
252 252
63 63
252 159
OWCP administers the Federal Employees' Compensation Act (FECA). A Peace Corps Volunteer who sustains an injury or contracts an illness overseas while in Peace Corps service may be entitled to benefits under the FECA. The Department of Labor authorizes the Peace Corps to furnish medical benefits to a volunteer, who is injured during the volunteer’s period of service, for a period of 120 days following termination if the service volunteer’s injury meets requirements.
US Code: 5 USC 8142 Name of Law: Peace Corps Volunteers
   US Code: 5 USC 8101 et.seq Name of Law: Federal Employees' Compensation Act
  
US Code: 5 USC 8101 et.seq Name of Law: Federal Employees' Compensation Act
US Code: 5 USC 8142 Name of Law: Peace Corps Volunteers
Not associated with rulemaking
  89 FR 51908 06/20/2024
90 FR 37889 08/06/2025
No
  Total Request 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 252 252 0 0 0 0
Annual Time Burden (Hours) 63 63 0 0 0 0
Annual Cost Burden (Dollars) 252 159 0 93 0 0
No
No
$11,457
No
    No
    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.
08/06/2025