Extension without change of a currently approved collection
No
Regular
11/21/2024
Requested
Previously Approved
36 Months From Approved
02/28/2025
1,392
1,164
640
580
25
21
These OWCP forms are used to obtain
information about amounts received as the result of final judgments
in litigation, or a settlement of the litigation, brought against a
third party who is liable for damages due to a Federal employee
comprehensive work-related injury.
US Code:
5 USC
8131 Name of Law: Federal Employees' Compensation Act
US Code: 5 USC
8132 Name of Law: Federal Employees' Compensation Act
The number of attorney business
respondents decreased by 40 due to an increase in the number of
individual respondents. This increase is due to the receipt of more
third-party claims received.
$42,983
No
Yes
Yes
No
No
No
No
Pamela Hamai 415 241-3350
hamai.pamela@dol.gov
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.