Overpayment Recovery Questionnaire

Forms and Documents

Document Name	Status
Form OWCP-20 Overpayment Recovery Questionnaire Form and Instruction	Modified
ss 1215-0144 (OWCP-20) 5-2-06.doc Supporting Statement A	2006-08-04

IC Document Collections

IC ID	Document Title	Status
38463	Overpayment Recovery Questionnaire Form and Instruction	Modified

ICR Details

OMB Control No: 1215-0144	ICR Reference No: 200608-1215-001
Status: Historical Active	Previous ICR Reference No: 200506-1215-010
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: Overpayment Recovery Questionnaire
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/16/2006
	Date Received in OIRA: 08/11/2006
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2009	36 Months From Approved	11/30/2006
Responses	4,020	0	4,520
Time Burden (Hours)	4,020	0	4,520
Cost Burden (Dollars)	1,768	0	2,000

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Abstract: Information collected with this form is used to evaluate the financial profile of OWCP beneficiaries who have been overpaid benefits, and their ability to repay. OWCP beneficiaries are typically retired coal miners disabled by black lung disease, Federal employees injured on the job, and their survivors.

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Authorizing Statute(s): US Code: 5 USC 923(b) Name of Law: Federal Coal Mine Health and Safety Act of 1969
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 29985	05/24/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 155	08/11/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Overpayment Recovery Questionnaire	OWCP-20	Overpayment Recovery Questionnaire

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ICR Summary of Burden

	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	4,020	4,520	0	0	-500	0
Annual Time Burden (Hours)	4,020	4,520	0	0	-500	0
Annual Cost Burden (Dollars)	1,768	2,000	0	0	-232	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There has been a reduction of 500 burden hours from 4,520 to 4,020 which is an adjustment of hours because benefit checks were issued after a beneficiary's death prior to notification of the death overpayments, repayment of the debt is not the burden of the person that received a descendant's benefits. The burden is on the bank that improperly failed to close the account and paid out the money. Rather than using the OWCP-20 form that a claimant debtor would complete, these overpayments are recovered using a protected need-to-know Department of Treasury website service to collect from the liable bank.

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Annual Cost to Federal Government: $131,331

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 08/11/2006

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