Representative Fee Request

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CA-155 Representative Fee Request	Form	Modified	Available
SS 1215-0078 (November 6, 2006).doc	Supporting Statement A	Uploaded 2007-01-05	Available
THE PRIVACY ACT OF 1974.doc	Supplementary Document	Uploaded 2007-01-05	Available
Section 928 attorneys' fees.doc	Supplementary Document	Uploaded 2007-01-05	Available
Section 10.700 through 10.703.doc	Supplementary Document	Uploaded 2007-01-05	Available
20 CFR 702.132 Fee for Services.doc	Supplementary Document	Uploaded 2007-01-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13744	Representative Fee Request	Form	Modified

ICR Details

OMB Control No: 1215-0078	ICR Reference No: 200611-1215-001
Status: Historical Active	Previous ICR Reference No: 200312-1215-001
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: Representative Fee Request
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: 03/28/2007
	Date Received in OIRA: 01/19/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2010	36 Months From Approved	03/31/2007
Responses	12,340	0	12,700
Time Burden (Hours)	7,675	0	7,850
Cost Burden (Dollars)	17,401	0	17,000

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Abstract: Individuals filing for compensation benefits with the Office of Workers’ Compensation Programs (OWCP) may be represented by an attorney or other representative. The representative is entitled to request a fee for services under 20 CFR 10.700-703 (Federal Employees’ Compensation Act) and 20 CFR 702.132 (Longshore and Harbor Workers’ Compensation Act). The fee must be approved by the OWCP before any demand for payment can be made by the representative. Under the FECA, the representative is required to submit for review any fees resulting from representing the claimant in filing for benefits. The program does not make payment, but reviews the fee request to ensure that it is consistent with services provided, and with customary local charges for similar services. Fee requests received have been used to approve attorney’s fees, allowing the attorney to pursue payment of an appropriate amount from the claimant. If the fee requested is considered excessive, in view of the criteria outlined in the regulations, the fee approved would be reduced accordingly.

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Authorizing Statute(s): None

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 56174	09/26/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 2559	01/19/2007
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Representative Fee Request	CA-155	Attorney Fee Letter

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ICR Summary of Burden

table that charts list 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	12,340	12,700	0	0	-360	0
Annual Time Burden (Hours)	7,675	7,850	0	0	-175	0
Annual Cost Burden (Dollars)	17,401	17,000	0	0	401	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 decrease in the Longshore burden hours because of a decrease in Longshore lost-time injuries reported and fee requests submitted. The increase in costs burden result from increase in postage costs.

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Annual Cost to Federal Government: $221,301

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: 01/19/2007

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