Claim for Reimbursement-Assisted Reemployment

Forms and Documents

Document Name	Status
Form CA-2231 Claim for Reimbursement-Assisted Reemployment Form	Modified
SS 1240-0018_revised.doc Supporting Statement A	2010-05-14
notice to reviewer revisions.doc Supplementary Document	2010-05-13
2009 opm salary table.pdf Supplementary Document	2010-05-04
Payroll and Timekeeping Clerks.htm Supplementary Document	2010-05-04
DOL GOVT-1.doc Supplementary Document	2010-05-04
Regulation Section 8104 - Vocational Rehabilitation[1].doc Supplementary Document	2010-05-04
THE PRIVACY ACT OF 1974[1].doc Supplementary Document	2010-05-04

IC Document Collections

IC ID	Document Title	Status
13892	Claim for Reimbursement-Assisted Reemployment Form	Modified

ICR Details

OMB Control No: 1240-0018	ICR Reference No: 201005-1240-001
Status: Historical Active	Previous ICR Reference No: 201003-1240-018
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Claim for Reimbursement-Assisted Reemployment
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/26/2010
	Date Received in OIRA: 05/28/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2013	36 Months From Approved	07/31/2010
Responses	100	0	80
Time Burden (Hours)	50	0	40
Cost Burden (Dollars)	47	0	34

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Abstract: To aid in the employment of Federal employees with disabilities related to an on-the-job injury, employers submit this form to claim reimbursement for wages paid under the assisted reemployment project. This information allows for a prompt decision on payment.

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Authorizing Statute(s): US Code: 5 USC 8104a Name of Law: FECA
   US Code: 5 USC 8101 Name of Law: Federal Employees' Compensation Act (FECA)
  

Citations for New Statutory Requirements: US Code: 5 USC 8101 Name of Law: Federal Employee's Compensation Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 7291	02/18/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 60062	05/28/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Claim for Reimbursement-Assisted Reemployment	CA-2231	Claim for Reimbursement Assisted Reemployment

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ICR Summary of Burden

	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	100	80	0	0	20	0
Annual Time Burden (Hours)	50	40	0	0	10	0
Annual Cost Burden (Dollars)	47	34	0	13	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The adjustments in the burden hours are due to an increase in the number of respondents. The previous approved number of annual respondents (20) is increased to (25), which represents an increase of 5 respondents. The approved number of hours is 40; the requested number of hours is 50, an increase of 10 hours. In addition, due to an increase in postage, the maintenance and reporting costs have increased from $34.00 to $47.00 which is an increase of $13.00.

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Annual Cost to Federal Government: $630

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 05/28/2010

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