Information Collection

Overpayment Recovery Questionnaire

IC 38463 under ICR 200902-1215-009 · OMB 1215-0144.

Documents and Forms

Document Name Document Type
Form OWCP-20 Overpayment Recovery Questionnaire Form and Instruction
OWCP-20 Overpayment Recovery Questionnaire owcp-20 8-11-2009.pdf www.dol.gov/esa/owcp/dfec/regs/compliance/OWCP-20.pdf Form and Instruction
DOL Privacy Act systems ESA-6.pdf DOL/ESA-6 IC Document
DOL-ESA-30.pdf DOL/ESA-30 IC Document
DOL ESA-49.pdf DOL/ESA-49 IC Document
Supporting regulations EEOICPA.pdf supporting regulations EEOICPA IC Document
7385j-2.pdf 7385j-2 IC Document
30 USC 923 (b).pdf 30 USC 923b IC Document
8129 Recovery of overpayments.pdf 8129 Recovery of Overpayment IC Document
Section 725.544(c) FR 12-20-2000.pdf Section 725.544(c) FR 12-20-2000 IC Document
Part 410 FCMHS Act of 1969, Title IV - BL Benefits.pdf Part 41- FCMHS Act of 1969, Title IV BL Benefits IC Document
BL Initial Overpayment Letter for OWCP-20.pdf BL Initial Overpayment letter for OWCP-20 IC Document
DOL GILS Record - Federal Empoyee Compensation System.pdf DOL GILS Record FECA Employee Compensation System IC Document
FECA Form Letter 1.pdf FECA Form Letter 1 IC Document
FECA Form Letter 2.pdf FECA Form Letter 2 IC Document
ESTABLISHMENT DATA ESTABLISHMENT DATA.pdf Establishment Data IC Document
Characteristics of Minimum Wage Employee.pdf Characteristics of Minimum Wage Employee IC Document
20 CFR 10.430-10.441.doc 20 CFR 10.430 - 10.441 IC Document
20 CFR 410 Subpart A.doc 20 CFR 410 Subpart A IC Document
Published FRN 1215-0144.pdf Published FRN 1215-0144 IC Document
20 CFR 410 Subpart B.doc 20 CFR 410 Subpart B IC Document
20 CFR 410 Subpart C.doc 20 CFR 410 Subpart C IC Document
20 CFR 410 Subpart D.doc 20 CFR 410 Subpart D IC Document
20 CFR 410 Subpart E.doc 20 CFR 410 Subpart E IC Document
20 CFR 410 Subpart F.doc 20 CFR 410 Subpart F IC Document
20 CFR 410 Subpart G.doc 20 CFR 410 Subpart G IC Document
Privacy Act Systems - DOL-GOVT-1.pdf DOL/GOVT-1 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Overpayment Recovery Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 725.544 (c) 20 CFR 10.430 - 10.441 20 CFR 30.510-520

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	OWCP-20	Overpayment Recovery Questionnaire	owcp-20 8-11-2009.pdf	http://www.dol.gov/esa/owcp/dfec/regs/compliance/OWCP-20.pdf	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/GOVT-1, ESA/DOL-6 Black Lung, DOL/ESA-30 Black Lung, DOL/ESA-49 EEOICPA	FR Citation: 67 FR 16869

Number of Respondents: 4,020	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,020	0	4,020
Annual IC Time Burden (Hours)	4,020	0	4,020
Annual IC Cost Burden (Dollars)	1,889	121	1,768

Documents for IC

Title	Document	Date Uploaded
DOL/ESA-6	DOL Privacy Act systems ESA-6.pdf	08/02/2006
DOL/ESA-30	DOL-ESA-30.pdf	08/02/2006
DOL/ESA-49	DOL ESA-49.pdf	08/02/2006
supporting regulations EEOICPA	Supporting regulations EEOICPA.pdf	08/02/2006
7385j-2	7385j-2.pdf	08/02/2006
30 USC 923b	30 USC 923 (b).pdf	08/02/2006
8129 Recovery of Overpayment	8129 Recovery of overpayments.pdf	08/02/2006
Section 725.544(c) FR 12-20-2000	Section 725.544(c) FR 12-20-2000.pdf	08/02/2006
Part 41- FCMHS Act of 1969, Title IV BL Benefits	Part 410 FCMHS Act of 1969, Title IV - BL Benefits.pdf	08/02/2006
BL Initial Overpayment letter for OWCP-20	BL Initial Overpayment Letter for OWCP-20.pdf	08/02/2006
DOL GILS Record FECA Employee Compensation System	DOL GILS Record - Federal Empoyee Compensation System.pdf	08/02/2006
FECA Form Letter 1	FECA Form Letter 1.pdf	08/02/2006
FECA Form Letter 2	FECA Form Letter 2.pdf	08/02/2006
Establishment Data	ESTABLISHMENT DATA ESTABLISHMENT DATA.pdf	08/02/2006
Characteristics of Minimum Wage Employee	Characteristics of Minimum Wage Employee.pdf	08/02/2006
20 CFR 10.430 - 10.441	20 CFR 10.430-10.441.doc	08/02/2006
20 CFR 410 Subpart A	20 CFR 410 Subpart A.doc	08/02/2006
Published FRN 1215-0144	Published FRN 1215-0144.pdf	08/03/2006
20 CFR 410 Subpart B	20 CFR 410 Subpart B.doc	08/04/2006
20 CFR 410 Subpart C	20 CFR 410 Subpart C.doc	08/04/2006
20 CFR 410 Subpart D	20 CFR 410 Subpart D.doc	08/04/2006
20 CFR 410 Subpart E	20 CFR 410 Subpart E.doc	08/04/2006
20 CFR 410 Subpart F	20 CFR 410 Subpart F.doc	08/04/2006
20 CFR 410 Subpart G	20 CFR 410 Subpart G.doc	08/04/2006
DOL/GOVT-1	Privacy Act Systems - DOL-GOVT-1.pdf	07/28/2009

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.