Notice of Recurrence

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CA-2a Notice of Recurrence	Form and Instruction	Modified	Available
6. 20cfr10.104[1].pdf	Supplementary Document	Uploaded 2011-01-20	Available
10. Salary Table 2010-RUS.mht	Supplementary Document	Uploaded 2011-01-20	Source copy available
9. Average hours and earnings of production and nonsupervisory employees.txt	Supplementary Document	Uploaded 2011-01-20	Available
3 Summary of Revisions for CA-2a 1 4-21-2011 final.doc	Supplementary Document	Uploaded 2011-04-21	Available
Supporting_Statement_1240-0009 04-27-2011.doc	Supporting Statement A	Uploaded 2011-04-27	Available
7. 5 usc 8101.mht	Supplementary Document	Uploaded 2011-01-20	Source copy available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13870	Notice of Recurrence	Form and Instruction	Modified

ICR Details

OMB Control No: 1240-0009	ICR Reference No: 201101-1240-001
Status: Historical Active	Previous ICR Reference No: 201003-1240-009
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Notice of Recurrence
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: 06/01/2011
	Date Received in OIRA: 05/02/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2014	36 Months From Approved	05/31/2011
Responses	314	0	680
Time Burden (Hours)	157	0	340
Cost Burden (Dollars)	148	0	299

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Abstract: This form is used by current, or occasionally former, Federal employees to claim wage loss or medical treatment resulting from a recurrence of a work-related injury while Federally employed. The information is necessary to ensure the accurate payment of benefits.

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Authorizing Statute(s): US Code: 5 USC 8101, et seq Name of Law: Federal Employees' Compensation Act
  

Citations for New Statutory Requirements: None

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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:
	76 FR 10071	02/23/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 24533	05/02/2011
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Notice of Recurrence	CA-2a	Notice of Recurrence

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ICR Summary of Burden

table that charts list 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	314	680	0	0	-366	0
Annual Time Burden (Hours)	157	340	0	0	-183	0
Annual Cost Burden (Dollars)	148	299	0	0	-151	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: While Form CA-2a has been revised, those changes are not expected to have a material effect on the time and cost burdens for this information collection. There are currently 6273 recurrences being submitted, a decrease of 7323 claims. There is a decrease of 366 in the number of claims being submitted by claimants who have left federal employment (i.e., 5% of 6273 = 314 versus the last submission of 680 (5% of 13,596 = 680. This results in a burden hour reduction of 183 (366 x .50) in this submission. The reporting burden hours in the previous submission were 340 and have changed to 157. The operation and maintenance costs have decreased $151.00 due to a reduction in the filing of claims (.47 x 314 = 148) versus $299 (.44 x 680 = 299), from the previous submission. The noted decreases described above are attributed to enhanced computer capabilities to track recurrence claims.

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Annual Cost to Federal Government: $5,374

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]? No

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: 05/02/2011

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