ACH Vendor Payment Enrollment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OWCP-3881 ACH Vendor Payment Enrollment Form	Form and Instruction	New	Repair queued
OCIO Supporting Statement_ACH EFT Form.docx	Supporting Statement A	Uploaded 2025-07-31	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
272881	ACH Vendor Payment Enrollment Form	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202412-1240-002
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: ACH Vendor Payment Enrollment
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/05/2025

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	35,424	0
Time Burden (Hours)	1,771	0
Cost Burden (Dollars)	280	0

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Abstract: The information provided is used by the bill processing contractor on behalf of the programs to direct payment to providers of medical and vocational rehabilitation services, accurately and in a timely manner.

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Authorizing Statute(s): US Code: 33 USC 901 Name of Law: Longshore and Harbor Workers' Compensation Act
   US Code: 5 USC 8101 Name of Law: Federal Employees Compensation Act
   US Code: 30 USC 901 Name of Law: Black Lung Benefits Act
   US Code: 42 USC 7384 Name of Law: Employees Occupational Illness 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:
	89 FR 86841	10/31/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 37570	08/05/2025
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
ACH Vendor Payment Enrollment Form	OWCP-3881	ACH Vendor Payment Enrollment Form

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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	35,424	0	0	35,424	0	0
Annual Time Burden (Hours)	1,771	0	0	1,771	0	0
Annual Cost Burden (Dollars)	280	0	0	280	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection and therefore not yet on the OMB inventory.

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Annual Cost to Federal Government: $164,293

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: 08/05/2025

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