Actuarial Attestation Regarding War Risk Hazard Provisions in Defense Base Act Premiums

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form WH2 Actuarial Attestation Regarding War Risk Hazard Provisions in Defense Base Act Premiums	Form and Instruction	New	Available
Supporting Statement 1240-0NEW Acturial Attestation Re War Risk Hazards in DBA Premiums (WH-2) OCIO1 - 6.1.26.docx	Supporting Statement A	Uploaded 2026-06-01	Available
Public Comment Received 12.17.25 from Arav'a Clerveus.pdf	Public Comments	Uploaded 2025-12-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
279219	Actuarial Attestation Regarding War Risk Hazard Provisions in Defense Base Act Premiums	Form and Instruction	New	Actuarial Attestation Regarding War Risk Hazard Provisions in Defense Base Act Premiums

ICR Details

OMB Control No:	ICR Reference No: 202602-1240-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Actuarial Attestation Regarding War Risk Hazard Provisions in Defense Base Act Premiums
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: 06/09/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	12	0
Time Burden (Hours)	12	0
Cost Burden (Dollars)	12	0

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Abstract: Under Section 104 of the War Hazards Compensation Act (WHCA), private insurance carriers or self-insured employers may seek reimbursement for payments made in conjunction with a WHCA-covered injury. Insurance carriers seeking WHCA reimbursement are required to submit an actuarial attestation annually to facilitate accurate claims processing. Each authorized insurance carrier shall submit this actuarial attestation by no later than March 1st of each year for all their Defense Base Act policies with policy effective dates during the preceding calendar year. For ease of administration, this requirement can be met through the use of this form. The information requested in this form is to be provided on an annual basis, though it can also be provided in another manner so long as it contains all requested information and attestation.

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Authorizing Statute(s): US Code: 42 USC § 1701 Name of Law: The War Hazards Compensation Act (WHCA)
  

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 58629	12/17/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 34836	06/09/2026
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
Actuarial Attestation Regarding War Risk Hazard Provisions in Defense Base Act Premiums	WH2	Actuarial Attestation Regarding War Risk Hazard Provisions in Defense Base Act Premiums

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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	12	0	0	12	0	0
Annual Time Burden (Hours)	12	0	0	12	0	0
Annual Cost Burden (Dollars)	12	0	0	12	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: $325

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: 06/09/2026

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