War Hazards Compensation Act Claims, Benefits, and Notices

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form WH-1 Notice of Injury or Disease and Claim for Benefits under the War Hazards Compensation Act	Form and Instruction	Modified	Available
Form CA-278 Claims for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards	Form and Instruction	Modified	Available
Supporting Statement 1240-0006 (CA-278 and new WH-1) OCIO4.docx	Supporting Statement A	Uploaded 2026-03-10	Available
60 day FRN correction posted 9.29.25.pdf	Supplementary Document	Uploaded 2026-03-02	Available
60 day FRN posted 9.10.25.pdf	Supplementary Document	Uploaded 2026-03-02	Available
WCPO-2025-0039-DRAFT-0003_Jessica Singleton.html	Public Comments	Uploaded 2025-11-20	Available
WCPO-2025-0039-DRAFT-0002_Samantha Sanford.html	Public Comments	Uploaded 2025-11-20	Available
OPM Salary Tables 2025.pdf	Supplementary Document	Uploaded 2025-11-20	Available
81 Fed. Reg. 47418 (July 21, 2016) (1).pdf	Supplementary Document	Uploaded 2025-11-20	Available
5 usc 8147 2025.docx	Supplementary Document	Uploaded 2025-11-20	Available
20 cfr 61.104.docx	Supplementary Document	Uploaded 2025-11-20	Available
20 cfr 61.101.docx	Supplementary Document	Uploaded 2025-11-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13940	Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act	Form and Instruction	Modified	Notice of Injury or Disease and Claim for Benefits under the War Hazards Compensation Act
13940	Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act	Form and Instruction	Modified	Claims for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards
13940	Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act	Form and Instruction	Modified

ICR Details

OMB Control No: 1240-0006	ICR Reference No: 202511-1240-002
Status: Received in OIRA	Previous ICR Reference No: 202303-1240-003
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: War Hazards Compensation Act Claims, Benefits, and Notices
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/17/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2026
Responses	2,528	1,264
Time Burden (Hours)	1,264	632
Cost Burden (Dollars)	5,840	2,427

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Abstract: Information collected using OWCP Form CA-278, Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act, allows 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 WH-1 Form, Notice of Injury or Disease and Claim for Benefits under the War Hazards Compensation Act, allows beneficiaries to file a claim under the WHCA and will simplify the process of filing an initial claim for benefits and gather the necessary information to expedite claim decisions and reimbursements.

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Authorizing Statute(s): US Code: 5 USC 8147 Name of Law: The Federal Employees' Compensation Act
   US Code: 5 USC 8121 Name of Law: Claim
   US Code: 42 USC 1701 Name of Law: War Hazards Compensation Act (WHCA)
   US Code: 5 USC 8145 Name of Law: Administration
   US Code: 5 USC 8149 Name of Law: Regulations
  

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:
	90 FR 43642	09/10/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 12623	03/16/2026
Did the Agency receive public comments on this ICR? Yes

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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
Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act	CA-278, WH-1	Claims for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards ,   Notice of Injury or Disease and Claim for Benefits under the War Hazards Compensation Act

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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	2,528	1,264	0	1,264	0	0
Annual Time Burden (Hours)	1,264	632	0	632	0	0
Annual Cost Burden (Dollars)	5,840	2,427	0	0	3,413	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: Respondents: The number of respondents increased from 7 to 14. This increase in respondents is due to the new WH-1 form being added to this collection. Responses: The number of responses increased from 1,264 to 2,528 due to the new WH-1 form being added to this collection Burden Hours: The total number of burden hours increase from 632 hours to 1,264 hours also due to the new WH-1 form being added to this collection. Costs to Respondents or Recordkeepers: Item 13 costs for this submission increased from $2,427.00 to $5,840.00 due to an increase in the mailing cost for first class mail and the increase in hourly rate for insurance claims and policy processing clerks.

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Annual Cost to Federal Government: $71,744

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.     No

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.     No

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: 03/17/2026

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