Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act

ICR 200612-1215-003

OMB: 1215-0202

Federal Form Document

Forms and Documents
ICR Details
1215-0202 200612-1215-003
Historical Active 200402-1215-001
DOL/ESA
Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
Extension without change of a currently approved collection   No
Regular
Approved without change 08/23/2007
Retrieve Notice of Action (NOA) 05/22/2007
  Inventory as of this Action Requested Previously Approved
08/31/2010 36 Months From Approved 08/31/2007
140 0 80
70 0 40
239 0 0

Information collected using Form CA-278 will allow OWCP to consider requests filed by insurance carriers and self-insured that have paid benefits to workers injured due to a war-risk hazard to be reimbursed for such benefits out of the Employees' Compensation Fund.

US Code: 42 USC 1701 Name of Law: War Hazards Compensation Act (WHCA)
   US Code: 5 USC 8147 Name of Law: The Federal Employees' Compensation Act
  
None

Not associated with rulemaking

  72 FR 1248 01/10/2007
72 FR 28552 05/21/2007
No

  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 140 80 0 0 60 0
Annual Time Burden (Hours) 70 40 0 0 30 0
Annual Cost Burden (Dollars) 239 0 0 0 239 0
No
No
The has been an adjustment of 40 burden hours to 70 burden hours which is an increae of 30 burden hours as a result of the number of claims being submitted due to the conflict in Iraq. There has been a change in the operation and maintenance cost due to an increase in postage from $97.00 to $239.00.

$62,053
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Macaire Carroll-Gavula 202 693-0819 [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.
05/22/2007


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