Overpayment Recovery Questionnaire

ICR 200902-1215-009

OMB: 1215-0144

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2009-08-18
Supplementary Document
2009-04-15
Supplementary Document
2009-02-25
Supplementary Document
2009-02-25
Supplementary Document
2009-02-25
IC Document Collections
IC ID
Document
Title
Status
38463 Modified
ICR Details
1215-0144 200902-1215-009
Historical Active 200608-1215-001
DOL/ESA
Overpayment Recovery Questionnaire
Extension without change of a currently approved collection   No
Regular
Approved without change 11/06/2009
Retrieve Notice of Action (NOA) 09/04/2009
  Inventory as of this Action Requested Previously Approved
11/30/2012 36 Months From Approved 11/30/2009
4,020 0 4,020
4,020 0 4,020
1,889 0 1,768

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.

US Code: 5 USC 923(b) Name of Law: Federal Coal Mine Health and Safety Act of 1969
   US Code: 42 USC 7385j-2 Name of Law: Federal Coal Mine Health and Safety Act
   US Code: 5 USC 8129(b) Name of Law: Federal Coal Mine Health and Safety Act
  
None

Not associated with rulemaking

  74 FR 15004 04/02/2009
74 FR 45879 09/04/2009
No

1
IC Title Form No. Form Name
Overpayment Recovery Questionnaire OWCP-20 Overpayment Recovery Questionnaire

  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 4,020 0 0 0 0
Annual Time Burden (Hours) 4,020 4,020 0 0 0 0
Annual Cost Burden (Dollars) 1,889 1,768 0 0 121 0
No
No

$145,562
No
No
Uncollected
Uncollected
No
Uncollected
Mark Bedont 202 693-0815 [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.
09/04/2009


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