Claim for Reimbursement-Assisted Reemployment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CA-2231 Claim for Reimbursement-Assisted Reemployment	Form	Modified	Available
DOL GOVT-1.docx	Supplementary Document	Uploaded 2019-07-15	Available
8104 vocational rehabilitation.docx	Supplementary Document	Uploaded 2019-07-15	Available
OPM Salary Table 2019.pdf	Supplementary Document	Uploaded 2019-07-15	Repair queued
Payroll and Timekeeping Clerks.htm	Supplementary Document	Uploaded 2019-07-15	Available
1240-0018 Supporting Statement (20190909) with corrections mjs 9-13-2019.docx	Supporting Statement A	Uploaded 2019-09-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13892	Claim for Reimbursement-Assisted Reemployment	Form	Modified

ICR Details

OMB Control No: 1240-0018	ICR Reference No: 201904-1240-001
Status: Active	Previous ICR Reference No: 201602-1240-007
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Claim for Reimbursement-Assisted Reemployment
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/12/2019
	Date Received in OIRA: 09/25/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2022	36 Months From Approved	12/31/2019
Responses	64	0	128
Time Burden (Hours)	32	0	64
Cost Burden (Dollars)	37	0	67

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Abstract: To aid in the employment of Federal employees with disabilities related to an on-the-job injury, employers submit Form CA-2231 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: Federal Employees' Compensation Act
   US Code: 5 USC 8101 Name of Law: Federal Employees' Compensation Act
   PL: Pub.L. 114 - 113 H Name of Law: Consolidated Appropriations Act , 2016
  

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:
	84 FR 20661	05/10/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 50478	09/25/2019
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
Claim for Reimbursement-Assisted Reemployment	CA-2231	Claim for Reimbursement Assisted Reemployment

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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	64	128	0	0	-64	0
Annual Time Burden (Hours)	32	64	0	0	-32	0
Annual Cost Burden (Dollars)	37	67	0	0	-30	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 a decrease in the number of participating employers. The previous approved number of annual respondents (32) decreased to approximately (16), which represents a decrease of 16 respondents. The previously approved number of burden hours was 64; the requested number of hours is 32, which is a decrease of 32 hours. In addition, postage and envelope costs, the maintenance and reporting costs is now $37.00, which is a reduction of $30.00, from the previous amount of $67.00

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Annual Cost to Federal Government: $459

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 09/25/2019

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