Rehabilitation Maintenance Certificate

Forms and Documents

Document	Type	Status	Availability
Form OWCP-17 Rehabilitation Maintenance Certificate	Form	Modified	Repair queued
Form OWCP-17 Rehabilitation Maintenance Certificate	Form	Modified	Repair queued
PC_202502-1240-004_042125_104431_1.pdf	Public Comments	Uploaded 2025-04-21	Repair queued
PC_202502-1240-004_042025_105923_1.pdf	Public Comments	Uploaded 2025-04-20	Repair queued
1240-0012 Supporting Statement 2025.docx	Supporting Statement A	Uploaded 2025-03-21	Repair queued
1240-0012 Supporting Statement 2025.docx	Supporting Statement A	Uploaded 2025-03-21	Repair queued
Rehabilitation Counselors Wages.pdf	Supplementary Document	Uploaded 2025-02-18	Repair queued
Rehabilitation Counselors Wages.pdf	Supplementary Document	Uploaded 2025-02-18	Missing upstream
Office of Workers' Compensation Programs Longshore and Harbor Workers' Compensation Act Case Files.docx	Supplementary Document	Uploaded 2025-02-18	Repair queued
Office of Workers' Compensation Programs Longshore and Harbor Workers' Compensation Act Case Files.docx	Supplementary Document	Uploaded 2025-02-18	Repair queued
Privacy Act Systems-FECA.docx	Supplementary Document	Uploaded 2025-02-18	Repair queued
Privacy Act Systems-FECA.docx	Supplementary Document	Uploaded 2025-02-18	Missing upstream
Office of Workers' Compensation Programs, Longshore and Harbor Worker's Compensation Act Special Fund System.docx	Supplementary Document	Uploaded 2025-02-18	Repair queued
Office of Workers' Compensation Programs, Longshore and Harbor Worker's Compensation Act Special Fund System.docx	Supplementary Document	Uploaded 2025-02-18	Repair queued

IC Document Collections

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

ICR Details

OMB Control No: 1240-0012	ICR Reference No: 202502-1240-004
Status: Active	Previous ICR Reference No: 202110-1240-001
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Rehabilitation Maintenance Certificate
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/23/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/21/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2028	36 Months From Approved	04/30/2025
Responses	1,288	0	3,452
Time Burden (Hours)	215	0	575
Cost Burden (Dollars)	0	0	0

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Abstract: Form OWCP-17 serves as a bill submitted by the program participant or OWCP, requesting reimbursement of expenses incurred due to participation in an approved rehabilitation effort for the preceding four-week period or fraction thereof.

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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:
	89 FR 88066	11/06/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 13391	03/21/2025
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
Rehabilitation Maintenance Certificate	OWCP-17	Rehabilitation Maintenance Certificate

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ICR Summary of Burden

	Total Approved	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	1,288	3,452	0	-2,164	0	0
Annual Time Burden (Hours)	215	575	0	-360	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The number of respondents and responses have decreased over the last three years. Responses decreased from 3,452 to 1,288. The decrease in responses therefore caused burden hours to also decrease from 575 to 215 due to several issues including: A general move to more online/virtual training and other vocational rehabilitation services during and since the pandemic, decreasing the need for reimbursement of expenses to claimants; The inception of a national contract for vocational rehabilitation services including fewer individual Rehabilitation Counselors; Programmatic changes in the Longshore program resulting in fewer vocational rehabilitation cases. It should be noted that usage of the form may again increase over the next cycle as resumption of in-person training and services increase moving out of the pandemic era.

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Annual Cost to Federal Government: $12,719

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: 03/21/2025

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