Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation

Forms and Documents

Document Name	Status
RETAIN Baseline Participant Form Part 1, revised for Phase 2 and Privacy Act Statement (CLEAN).docx Supplementary Document	2021-05-03
RETAIN Baseline Participant Form Part 1, revised for Phase 2 and Privacy Act Statement with changes (RLSO).docx Supplementary Document	2021-05-03
Justification Statement for Nonsubstantive Change 043021.docx Justification for No Material/Nonsubstantive Change	2021-04-30
RETAIN Statement A.docx Supporting Statement A	2019-12-03
RETAIN Statement B.docx Supporting Statement B	2019-04-04
RTW Coordinator Data Collection Tool.docx Supplementary Document	2019-04-02
Appendix A Individual Level Data Collection Tool.xlsx Supplementary Document	2019-04-02
Appendix A Program Data Collection Tool.xlsx Supplementary Document	2019-04-02
Quarterly Progress Report Appendix A.docx Supplementary Document	2019-04-02
signed part B review ODEP RETAIN_03_27_2019.pdf Supplementary Document	2019-04-01
60-day FRN-RETAIN_2018-13437.pdf Supplementary Document	2019-03-25

IC Document Collections

IC ID	Document Title	Status
235436	Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation Other-Survey	Modified

ICR Details

OMB Control No: 1230-0014	ICR Reference No: 202104-1230-001
Status: Received in OIRA	Previous ICR Reference No: 202101-1230-001
Agency/Subagency: DOL/ODEP	Agency Tracking No:
Title: Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/03/2021

	Requested	Previously Approved
Expiration Date	05/31/2022	05/31/2022
Responses	5,333	5,333
Time Burden (Hours)	1,778	1,778
Cost Burden (Dollars)	146,817	146,817

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Abstract: The RETAIN Demonstration Projects are a collaborative effort led by the U.S. Department of Labor’s Office of Disability Employment Policy (ODEP) in partnership with DOL’s Employment and Training Administration (ETA) and the Social Security Administration (SSA). RETAIN—Retaining Employment and Talent after Injury/Illness Network—projects will test the impact of early intervention strategies that improve stay-at-work/return-to-work (SAW/RTW) outcomes of individuals who experience work disability while employed. “Work disability” is defined as an injury, illness, or medical condition that has the potential to inhibit or prevent continued employment or labor force participation. SAW/RTW programs succeed by returning injured or ill workers to productive work as soon as medically possible during their recovery process and by providing interim part-time or light-duty work and accommodations, as necessary. The RETAIN Demonstration Projects are modeled after promising programs operating in Washington state, including the Centers of Occupational Health and Education (COHE), the Early Return to Work (ERTW), and the Stay at Work programs. While these programs operate within the state’s workers’ compensation system and are available only to people experiencing work-related injuries or illnesses, the RETAIN Demonstration Projects provide opportunities to improve SAW/RTW outcomes for both occupational and non-occupational injuries and illnesses of people who are employed, or at a minimum in the labor force, when their injury or illness occurs.

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Authorizing Statute(s): PL: Pub.L. 115 - 245 79 Name of Law: Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019
  

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:
	83 FR 29137	06/21/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 14401	04/10/2019
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
Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation	Spanish version of Disclosure Form, RETAIN SSA Authorization of Disclosure Form	RETAIN SSA Authorization of Disclosure Form ,   Spanish version of Disclosure Form

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ICR Summary of Burden

	Total Request	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	5,333	5,333	0	0	0	0
Annual Time Burden (Hours)	1,778	1,778	0	0	0	0
Annual Cost Burden (Dollars)	146,817	146,817	0	0	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:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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? No

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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: 05/03/2021

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