| TITLE OF INFORMATION COLLECTION REQUEST |
OMB CONTROL NO. |
| Self-Certification Medical Statement |
0579-0196 |
| DATE PREPARED |
| March 17, 2021 |
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OPM PAY TABLE |
09/2019
Benefits account for 38% of employee costs
and wages account for the remaining 62%.
W = .62 x TC
TC = 1.6129 x W
FB = .38 x TC
TC = 2.6316 x FB
2.6316 x FB = TC = 1.6129 x W
FB = (1.6129 / 2.6316) x W
FB = .613 x W
Fringe Benefits = Wages x .613
FRINGE BENEFITS FACTOR |
OVERHEAD COST FACTOR |
TOTAL FEDERAL GOVERNMENT COSTS |
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(A) |
(B) |
(C) |
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2021-MSP |
0.613 |
0.139 |
$6,612 |
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| ACTIVITY DESCRIPTION (incl form number) |
TOTAL ANNUAL RESPONSES |
AVG TIME PER RESPONSES |
TOTAL HOURS PER YEAR |
SALARY |
TOTAL COSTS |
| GRADE |
WAGE (Step 4) |
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(D) |
(E) |
(F) |
(G) |
(H) |
(1+B+C) X F X H |
| Self-Certification Medical Statement |
608 |
0.167 |
102 |
11 |
36.64 |
$6,548 |
| Request for Waiver |
1 |
1.000 |
1 |
11 |
36.64 |
$64 |
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