SUPPORTING STATEMENT
REQUEST FOR EMPLOYMENT INFORMATION
1215-0105 (CA-1027)
A. Justification.
1. 5 U.S.C. 8106 requires payment of compensation for partial disability to injured Federal employees. That section also requires the Office of Workers' Compensation (OWCP) to obtain information regarding a claimant's earnings during a period of eligibility to compensation. The CA-1027 is used to obtain earning information for an individual who is employed by a private employer. This information is used to determine the claimant's entitlement to compensation benefits.
2. The information collected is used by claims examiners for OWCP to determine the appropriate level of benefits to be paid to a claimant.
3. In accordance with the Government Paperwork Elimination Act (GPEA), DOL recognizes the requirement that all OMB Forms be made electronically interactive and have reviewed the CA-1027, Request for Employment Information with consideration of this goal.
Due to the low volume of usage for the CA-1027, this form is not a candidate for electronic submission and the fact that it is not a claim for compensation under the FECA Act also makes it a less likely candidate for electronic submission. The current version of the letter is not set up to allow the claimant to address his or her own employment independently; rather it allows the employer to respond to the U.S. Department of Labor’s inquiry concerning the employment status of the injured worker. For this reason, the form will not be placed on the DOL Form Website for claimant downloading.
4. The information collected via the CA-1027 is not duplicated anywhere within OWCP or any other Federal agency.
5. This information collection does not have a significant economic impact on a substantial number of small entities.
6. If this information were requested less frequently, claimants could receive compensation to which they were not entitled, creating overpayments which are difficult to recover.
7. There are no special circumstances impacting this collection.
8. The last Federal Register Notice inviting comment was published on August 15, 2006. No comments were received.
9. No payment or gift is provided to respondents.
10. The information collected by this form is maintained in the FECA claim files, which are fully protected under the Privacy Act. The applicable system of records is DOL/GOVT-1.
11. This form does not ask questions of a sensitive nature.
12. Approximately 500 CA-1027s are sent each year requesting information from private employers. The form is very straightforward, and the information requested on the form is readily available to the respondents. It is estimated that the form can be completed in an average of 15 minutes, including time to look up the information and write it on the form. The total burden hours have been calculated to be 125.
Because the wage category of the respondent is unknown, we have estimated the cost of the burden hours using the National Average Weekly Wage for production or nonsupervisory workers on private nonagriculture payrolls as computed by BLS, or $16.70 per hour. (Rounded to 2,088.00) $16.70 X 125 hours = $2,087.50.
13. The annual operating and maintenance cost to respondents consists of $210.00 in postage necessary to mail the form (500 x $.42 postage and envelope).
14. This form is printed by the automated Correspondence Library in OWCP when prompted by a claims examiner. It is estimated that the time required keying each form, reviewing each completed form and processing the information received takes approximately 20 minutes, or a total of approximately 167 hours. An average salary for an OWCP claims examiner is a GS-11, Step 1, earning $24.90 per hour. (167 x $24.90 = $4158.00)
The mailing costs equal $.42 per form for postage and envelope. (.42 x 500 = $210)
The total processing costs to the Federal government therefore are is
Generate/process/postage $4158 + $210 =
$4,368.00
15. There is no change in the burden hours since the last submission. However there is an increase in the operation and maintenance cost from $200 to $210 due to an increase in postage.
16. The collected information will not be published.
17. No exception is requested for the display of the OMB number and expiration date.
18. There is no exception to certification.
| File Type | application/msword |
| File Title | SUPPORTING STATEMENT |
| Author | Administrator |
| Last Modified By | U.S. Department of Labor |
| File Modified | 2006-12-18 |
| File Created | 2006-12-18 |