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Agency Information Collection Activities; Submission for OMB Review; Comment Request; Statement of Recovery Forms

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Information about this document as published in the Federal Register.

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The Department of Labor (DOL) is submitting the Office of Workers' Compensation Programs (OWCP) sponsored information collection request (ICR) revision titled, “Statement of Recovery Forms,” to the Office of Management and Budget (OMB) for review and approval for use in accordance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C. 3501 et seq.). Public comments on the ICR are invited.


The OMB will consider all written comments that agency receives on or before September 8, 2015.


A copy of this ICR with applicable supporting documentation; including a description of the likely respondents, proposed frequency of response, and estimated total burden may be obtained free of charge from the Web site at​public/​do/​PRAViewICR?​ref_​nbr=​201504-1240-001 (this link will only become active on the day following publication of this notice) or by contacting Michel Smyth by telephone at 202-693-4129, TTY 202-693-8064, (these are not toll-free numbers) or sending an email to

Submit comments about this request by mail or courier to the Office of Information and Regulatory Affairs, Attn: OMB Desk Officer for DOL-OWCP, Office of Management and Budget, Room 10235, 725 17th Street NW., Washington, DC 20503; by Fax: 202-395-5806 (this is not a toll-free number); or by email: Commenters are encouraged, but not required, to send a courtesy copy of any comments by mail or courier to the U.S. Department of Labor—OASAM, Office of the Chief Information Officer, Attn: Departmental Information Compliance Management Program, Room N1301, 200 Constitution Avenue NW., Washington, DC 20210; or by email:

For Further Information: Contact Michel Smyth by telephone at 202-693-4129, TTY 202-693-8064, (these are not toll-free numbers) or sending an email to

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Authority: 44 U.S.C. 3507(a)(1)(D).

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This ICR seeks approval under the PRA for revisions to the Statement of Recovery Forms information collection (Forms CA-1108 and CA-1122). The forms are used to obtain information about amounts received from a 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. A Federal employee can sustain a work-related injury, for which he or she is eligible for compensation under the Federal Employees' Compensation Act (FECA), under circumstances that also create a legal liability for some third party to pay damages for the same injury. When this occurs, the FECA authorizes the Secretary of Labor either to require the employee to assign his or her right of action to the United States or to prosecute the action. See 5 U.S.C. 8131. An employee receiving a judgment or a settlement of the action must reimburse the United States (U.S.) for past compensation payments; if there are surplus future compensation payments, the FECA provides that the employee must refund to the U.S. the amount of compensation paid by the U.S. and credit any surplus on future payments of compensation. See 5 U.S.C. 8132. This information collection has been classified as a revision, because the OWCP has updated Form CA-1108 so that it automatically calculates attorney fee and court cost information, provides information about the employee's net entitlement, clarifies the instructions, and includes the case file number; Form CA-1122 has been changed to include the case file number and employee's name. The FECA authorizes this information collection. See 5 U.S.C. 8121, 8132, 8149

This information collection is subject to the PRA. A Federal agency generally cannot conduct or sponsor a collection of information, and the public is generally not required to respond to an information collection, unless it is approved by the OMB under the PRA and displays a currently valid OMB Control Number. In addition, notwithstanding any other provisions of law, no person shall generally be subject to penalty for failing to comply with a collection of information that does not display a valid Control Number. See 5 CFR 1320.5(a) and 1320.6. The DOL obtains OMB approval for this information collection under Control Number 1240-0001. The current approval is scheduled to expire on August 31, 2015; however, the DOL notes that existing information collection requirements submitted to the OMB receive a month-to-month extension while they undergo review. New requirements would only take effect upon OMB approval. For additional substantive information about this ICR, see the related notice published in the Federal Register on May 11, 2015 (80 FR 26955).

Interested parties are encouraged to send comments to the OMB, Office of Information and Regulatory Affairs at the address shown in the ADDRESSES section within thirty (30) days of publication of this notice in the Federal Register. In order to help ensure appropriate consideration, comments should mention OMB Control Number 1240-0001. The OMB is particularly interested in comments that:

  • Evaluate whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have practical utility;
  • Evaluate the accuracy of the agency's estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used;
  • Enhance the quality, utility, and clarity of the information to be collected; and
  • Minimize the burden of the collection of information on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses.

Agency: DOL-OWCP.

Title of Collection: Statement of Recovery Forms.

OMB Control Number: 1240-0001.

Affected Public: Individuals or Households and Private Sector—businesses or other for-profits.

Total Estimated Number of Respondents: 842.

Total Estimated Number of Responses: 842.

Total Estimated Annual Time Burden: 419.

Total Estimated Annual Other Costs Burden: $219.

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Dated: August 3, 2015.

Michel Smyth,

Departmental Clearance Officer.

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[FR Doc. 2015-19457 Filed 8-6-15; 8:45 am]