Representative Fee Request

ICR 201003-1240-049

OMB: 1240-0049

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2009-10-30
Supplementary Document
2007-01-05
Supplementary Document
2007-01-05
Supplementary Document
2007-01-05
Supplementary Document
2007-01-05
IC Document Collections
IC ID
Document
Title
Status
13744 Modified
ICR Details
1240-0049 201003-1240-049
Historical Active 200611-1215-001
DOL/OWCP
Representative Fee Request
Extension without change of a currently approved collection   No
Regular
Approved without change 03/26/2010
Retrieve Notice of Action (NOA) 03/26/2010
  Inventory as of this Action Requested Previously Approved
12/31/2012 36 Months From Approved
8,404 0 12,340
5,419 0 7,675
12,806 0 17,401

Individuals filing for compensation benefits with the Office of Workers’ Compensation Programs (OWCP) may be represented by an attorney or other representative. The representative is entitled to request a fee for services under 20 CFR 10.700-703 (Federal Employees’ Compensation Act) and 20 CFR 702.132 (Longshore and Harbor Workers’ Compensation Act). The fee must be approved by the OWCP before any demand for payment can be made by the representative. Under the FECA, the representative is required to submit for review any fees resulting from representing the claimant in filing for benefits. The program does not make payment, but reviews the fee request to ensure that it is consistent with services provided, and with customary local charges for similar services. Fee requests received have been used to approve attorney’s fees, allowing the attorney to pursue payment of an appropriate amount from the claimant. If the fee requested is considered excessive, in view of the criteria outlined in the regulations, the fee approved would be reduced accordingly.

US Code: 5 USC 8101 et seq Name of Law: Federal Employees' Compensation Act
  
None

Not associated with rulemaking

  74 FR 46237 09/08/2009
74 FR 59243 11/17/2009
No

1
IC Title Form No. Form Name
Representative Fee Request ca-143 attorney fee request

  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 8,404 12,340 0 0 -3,936 0
Annual Time Burden (Hours) 5,419 7,675 0 0 -2,256 0
Annual Cost Burden (Dollars) 12,806 17,401 0 0 -4,595 0
No
No
The reduction in burden hours results from a reduction in reporting of lost time injuries under the Longshore Act and to a decrease in the number of actual requests for approval of attorney fees under the Federal Employee's Compensation Act..

$161,923
No
No
Uncollected
Uncollected
No
Uncollected
Cheryl Jordan 202 693-0289 [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.
11/17/2009


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