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Federal forms, ICRs, and supporting documents

Information Collection Request

Actuarial Attestation Regarding War Risk Hazard Provisions in Defense Base Act Premiums

ICR 202602-1240-001 · OMB unassigned · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form WH2 Actuarial Attestation Regarding War Risk Hazard Provisions in Defense Base Act Premiums Form and Instruction New Available
Supporting Statement 1240-0NEW Acturial Attestation Re War Risk Hazards in DBA Premiums (WH-2) OCIO1 - 6.1.26.docx Supporting Statement A Uploaded 2026-06-01 Available
Public Comment Received 12.17.25 from Arav'a Clerveus.pdf Public Comments Uploaded 2025-12-17 Available
IC Document Collections
IC IDCollectionTypeStatusForm
279219 Actuarial Attestation Regarding War Risk Hazard Provisions in Defense Base Act Premiums Form and Instruction NewActuarial Attestation Regarding War Risk Hazard Provisions in Defense Base Act Premiums
ICR Details
202602-1240-001
Received in OIRA
DOL/OWCP
Actuarial Attestation Regarding War Risk Hazard Provisions in Defense Base Act Premiums
New collection (Request for a new OMB Control Number)   No
Regular 06/09/2026
  Requested Previously Approved
36 Months From Approved
12 0
12 0
12 0
Under Section 104 of the War Hazards Compensation Act (WHCA), private insurance carriers or self-insured employers may seek reimbursement for payments made in conjunction with a WHCA-covered injury. Insurance carriers seeking WHCA reimbursement are required to submit an actuarial attestation annually to facilitate accurate claims processing. Each authorized insurance carrier shall submit this actuarial attestation by no later than March 1st of each year for all their Defense Base Act policies with policy effective dates during the preceding calendar year. For ease of administration, this requirement can be met through the use of this form. The information requested in this form is to be provided on an annual basis, though it can also be provided in another manner so long as it contains all requested information and attestation.
US Code: 42 USC § 1701 Name of Law: The War Hazards Compensation Act (WHCA)
  
None
Not associated with rulemaking
  90 FR 58629 12/17/2025
91 FR 34836 06/09/2026
Yes
  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 12 0 0 12 0 0
Annual Time Burden (Hours) 12 0 0 12 0 0
Annual Cost Burden (Dollars) 12 0 0 12 0 0
Yes
Miscellaneous Actions
No
This is a new collection and therefore not yet on the OMB Inventory.
$325
No
    No
    No
No
No
No
No
Ebony Henry 212 863-0831 [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.
06/09/2026