Death Gratuity

ICR 200908-1215-001

OMB: 1215-0206

Federal Form Document

Forms and Documents
ICR Details
1215-0206 200908-1215-001
Historical Active
DOL/ESA
Death Gratuity
New collection (Request for a new OMB Control Number)   No
Emergency 09/28/2009
Approved with change 11/03/2009
Retrieve Notice of Action (NOA) 08/28/2009
Approved as revised by DOL.
  Inventory as of this Action Requested Previously Approved
05/31/2010 6 Months From Approved
2,635 0 0
659 0 0
12 0 0

The National Defense Authorization Act for Fiscal Year 2008, Public Law 110-181, was enacted on January 28, 2008. Section 1105 of P.L. 110-181 amended the Federal Employees’ Compensation Act (FECA) creating a new section 8102a effective upon enactment. This section establishes a new FECA death gratuity benefit of up to $100,000 for eligible beneficiaries of federal employees and Non-Appropriated Fund Instrumentality (NAFI) employees who die from injuries incurred in connection with service with an Armed Force in a contingency operation. Section 8102a also permits agencies to authorize retroactive payment of the death gratuity for employees who died on or after October 7, 2001, in service with an Armed Force in the theater of operations of Operation Enduring Freedom and Operation Iraqi Freedom. To help it exercise its responsibility to administer this benefit, the Office of Workers’ Compensation Programs (OWCP) has promulgated an interim final rule. The statute and regulations allow for employees to vary the statutory order of precedence for beneficiaries and to designate alternative recipients of this benefit. Form CA-40 requests the information necessary from the employee to accomplish this variance. Form CA-41 provides the means for those named beneficiaries and possible recipients to file claims for those benefits and requests information from such claimants so that OWCP may determine their eligibility for payment. Further, the statute and regulations require agencies to notify OWCP immediately upon the death of a covered employee. CA-42 provides the means to accomplish this notification and requests information necessary to administer any claim for benefits resulting from such a death.
In accordance with 5 CFR 1320.13, emergency processing of this collection is requested and is essential to the mission of the agency; the agency cannot reasonably comply with the normal clearance procedures under this Part because the use of normal clearance procedures is reasonably likely to prevent or disrupt the collection of information or is reasonably likely to cause a statutory deadline to be missed. The agency has taken all practicable steps to consult with interested agencies and members of the public to minimize the burden of the collection of this information. Under 5 CFR 1320.13, it is requested that this collection be submitted and approved on an emergency basis. Under the National Defense Authorization Act for FY2008, an amendment to the FECA allows for immediate death gratuity payments to eligible survivors of Federal employees and employees of nonappropriated funded instrumentalities (NAFI) who die of injuries sustained in connection with the employee's service with an Armed Force serving in a contingency operation. While the Public Law became effective January 28, 2008, it also provides a provision in which a death gratuity may also be paid to eligible survivors of employees from certain agencies who died on or after October 7, 2001, due to injuries incurred in connection with the service of an Armed Force in the theatre of operations of Operation Enduring Freedom and Operation Iraqi Freedom. The OWCP FECA has been delegated the authority to administer the adjudication of claims and payment of the death gratuity under new section 5 U.S.C. 8102a, and has initiated a new collection with 3 distinct forms to meet stature requirements. Because of the immediate and retroactive provisions of this Law, the Agency requests that an immediate review and authorization of this collection be approved for 180 days to implement section 8102a. The agency will subsequently follow up with normal processing procedures to allow for the routine three year extension of this collection.

PL: Pub.L. 110 - 181 1105 Name of Law: National Defense Authorization Act
   US Code: 5 USC 8102a Name of Law: Amendment to the FECA, Death Gratuity
  
PL: Pub.L. 110 - 181 1105 Name of Law: null

1215-AB66 Final or interim final rulemaking 74 FR 41617 08/18/2009

  74 FR 45880 09/04/2009
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 2,635 0 2,635 0 0 0
Annual Time Burden (Hours) 659 0 659 0 0 0
Annual Cost Burden (Dollars) 12 0 12 0 0 0
No
No
This is a new collection request. There are minimal expense associated with the annual cost burden. The CA-40 is a beneficiary designation and maintained by the employing agency; in the event a claim is file for benefits by a designated beneficiary, a CA-41 is used and based on the anticipated number of respondents (25) x mailing and envelope costs (.47 cents), the annual cost burden is only $12.00. There is no cost to the public as the CA-42 is filed by the employing agency.

$35,624
No
No
Uncollected
Uncollected
No
Uncollected
Marcus Sharpless 202 693-0998 [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.
08/28/2009


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