Rehabilitation Maintenance Certificate

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OWCP-17 Rehabilitation Maintenance Certificate	Form	Modified	Repair queued
Occupational Employment and Wages for Rehabilitation Counselors BLS May 2020.docx	Supplementary Document	Uploaded 2022-01-11	Repair queued
Supporting Statement for 1240-0012 final.docx	Supporting Statement A	Uploaded 2022-01-11	Repair queued
Office of Workers' Compensation Programs Longshore and Harbor Workers' Compensation Act Case Files.docx	Supplementary Document	Uploaded 2021-11-15	Repair queued
Office of Workers' Compensation Programs, Longshore and Harbor Worker's Compensation Act Special Fund System.docx	Supplementary Document	Uploaded 2021-11-15	Repair queued
Privacy Act Systems-FECA.docx	Supplementary Document	Uploaded 2021-11-15	Repair queued
General Schedule.html	Supplementary Document	Uploaded 2021-10-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43809	Rehabilitation Maintenance Certificate	Form	Modified

ICR Details

OMB Control No: 1240-0012	ICR Reference No: 202110-1240-001
Status: Received in OIRA	Previous ICR Reference No: 202008-1240-063
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Rehabilitation Maintenance Certificate
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/14/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	02/28/2022
Responses	694	3,452
Time Burden (Hours)	118	575
Cost Burden (Dollars)	0	0

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Abstract: Since the last clearance, the responses from the respondents decreased from 3,452 to 694, which is an adjustment of 2,758. Accordingly, the burden hours decreased from 575 to 118, an adjustment of 457 hours. While no changes were made to this ICR, the reduction can be attributed to programmatic changes in both the FECA and Longshore programs that impacted the number of rehabilitation referrals.

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Authorizing Statute(s): US Code: 5 USC 8121 Name of Law: Federal Employees’ Compensation Act
   US Code: 33 USC 939 Name of Law: Longshore and Harbor Workers’ Compensation Act
   US Code: 33 USC 908(g) Name of Law: Longshore and Harbor Workers’ Compensation Act
   US Code: 5 USC 8111 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:
	86 FR 55861	10/07/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 2457	01/14/2022
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
Rehabilitation Maintenance Certificate	OWCP-17	Rehabilitation Maintenance Certificate

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ICR Summary of Burden

table that charts list 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	694	3,452	0	0	-2,758	0
Annual Time Burden (Hours)	118	575	0	0	-457	0
Annual Cost Burden (Dollars)	0	0	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: As indicated in item 12, since the last clearance, the responses from the respondents decreased from 3,452 to 694, which is an adjustment of 2,758. Accordingly, the burden hours decreased from 575 to 118, an adjustment of 457 hours. We attribute the reduction due to programmatic changes in both the FECA and Longshore programs that impacted the number of rehabilitation referrals.

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Annual Cost to Federal Government: $7,714

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? 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: 01/14/2022

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