Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act

ICR 202208-1240-002

OMB: 1240-0006

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2022-08-02
Supplementary Document
2020-01-08
Supporting Statement A
2022-08-02
Supplementary Document
2019-11-27
Supplementary Document
2019-11-27
Supplementary Document
2019-11-27
Supplementary Document
2019-11-27
Supplementary Document
2019-11-27
ICR Details
1240-0006 202208-1240-002
Received in OIRA 201911-1240-005
DOL/OWCP
Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
No material or nonsubstantive change to a currently approved collection   No
Regular 08/10/2022
  Requested Previously Approved
07/31/2023 07/31/2023
812 812
406 406
7,742 7,742

Information collected using Form CA-278 will allow OWCP to consider requests filed by insurance carriers and self-insured that have paid benefits to workers injured due to a war-risk hazard to be reimbursed for such benefits out of the Employees' Compensation Fund. The program requests clearance by the expiration date of March 31, 2020. he No material/Nonsubstantive Change is requests that the address be revised on item 1 of the instructions of the form which requires that the completed form be sent to OWCP. The new Division is now noted as OWCP Division of Federal Employees', Longshore and Harbor Workers' Compensation (DFELHWC). The address on item should now be noted as Office of Workers' Compensation Programs, Division of Federal Employees', Longshore and Harbor Workers' Compensation, Federal Employees' Compensation Act, (OWCP/DFELHWC-FECA), PO Box 8311, London, KY 4072-

US Code: 5 USC 8147 Name of Law: The Federal Employees' Compensation Act
   US Code: 42 USC 1701 Name of Law: War Hazards Compensation Act (WHCA)
   US Code: 5 USC 8121 Name of Law: Claim
   US Code: 5 USC 8145 Name of Law: Administration
   US Code: 5 USC 8149 Name of Law: Regulations
  
None

Not associated with rulemaking

  85 FR 2149 01/14/2020
85 FR 17366 03/27/2020
No

  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 812 812 0 0 0 0
Annual Time Burden (Hours) 406 406 0 0 0 0
Annual Cost Burden (Dollars) 7,742 7,742 0 0 0 0
No
No
The previous approved number of 345 is now 812, which an increase of 467. Due to the increase in the number of respondents, the previously approved number of burden hours (173), is now (406), an increase of 233. The costs burden increased from $542 to $7,742, which is an adjustment of $7,200. Previously, this figure was based on operational and mailing costs incurred by the respondent. This figure now shows the monetized value of respondents time which is matched with the annual cost burden figure, which explains this significant increase.

$19,228
No
    No
    No
No
No
No
No
Marcus Sharpless 202 693-0998 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/10/2022


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