80 FR 47527 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Statement of Recovery Forms

DEPARTMENT OF LABOR
Office of the Secretary

Federal Register Volume 80, Issue 152 (August 7, 2015)

Page Range		47527-47527
FR Document		2015-19457

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.

Federal Register, Volume 80 Issue 152 (Friday, August 7, 2015)

[Federal Register Volume 80, Number 152 (Friday, August 7, 2015)]
[Notices]
[Page 47527]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-19457]



[[Page 47527]]

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DEPARTMENT OF LABOR

Office of the Secretary


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

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: 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.

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

ADDRESSES: 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 RegInfo.gov Web site at http://www.reginfo.gov/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 [email protected].
    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: [email protected]. 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: [email protected].
    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 [email protected].

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

SUPPLEMENTARY INFORMATION: 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.

    Dated: August 3, 2015.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2015-19457 Filed 8-6-15; 8:45 am]
BILLING CODE 4510-CH-P

Federal Register / Vol. 80, No. 152 / Friday, August 7, 2015 / Notices 47527

DEPARTMENT OF LABOR SUPPLEMENTARY INFORMATION: This ICR collection requirements submitted to the
seeks approval under the PRA for OMB receive a month-to-month
Office of the Secretary revisions to the Statement of Recovery extension while they undergo review.
Forms information collection (Forms New requirements would only take
Agency Information Collection CA–1108 and CA–1122). The forms are effect upon OMB approval. For
Activities; Submission for OMB used to obtain information about additional substantive information
Review; Comment Request; Statement amounts received from a final about this ICR, see the related notice
of Recovery Forms judgments in litigation, or a settlement published in the Federal Register on
of the litigation, brought against a third May 11, 2015 (80 FR 26955).
ACTION: Notice. party who is liable for damages due to Interested parties are encouraged to
SUMMARY: The Department of Labor a Federal employee comprehensive send comments to the OMB, Office of
(DOL) is submitting the Office of work-related injury. A Federal employee Information and Regulatory Affairs at
Workers’ Compensation Programs can sustain a work-related injury, for the address shown in the ADDRESSES
(OWCP) sponsored information which he or she is eligible for section within thirty (30) days of
collection request (ICR) revision titled, compensation under the Federal publication of this notice in the Federal
‘‘Statement of Recovery Forms,’’ to the Employees’ Compensation Act (FECA), Register. In order to help ensure
Office of Management and Budget under circumstances that also create a appropriate consideration, comments
(OMB) for review and approval for use legal liability for some third party to pay should mention OMB Control Number
in accordance with the Paperwork damages for the same injury. When this 1240–0001. The OMB is particularly
Reduction Act (PRA) of 1995 (44 U.S.C. occurs, the FECA authorizes the interested in comments that:
3501 et seq.). Public comments on the Secretary of Labor either to require the
employee to assign his or her right of • Evaluate whether the proposed
ICR are invited. collection of information is necessary
action to the United States or to
DATES: The OMB will consider all for the proper performance of the
prosecute the action. See 5 U.S.C. 8131.
written comments that agency receives An employee receiving a judgment or a functions of the agency, including
on or before September 8, 2015. settlement of the action must reimburse whether the information will have
ADDRESSES: A copy of this ICR with the United States (U.S.) for past practical utility;
applicable supporting documentation; compensation payments; if there are • Evaluate the accuracy of the
including a description of the likely surplus future compensation payments, agency’s estimate of the burden of the
respondents, proposed frequency of the FECA provides that the employee proposed collection of information,
response, and estimated total burden must refund to the U.S. the amount of including the validity of the
may be obtained free of charge from the compensation paid by the U.S. and methodology and assumptions used;
RegInfo.gov Web site at http:// credit any surplus on future payments • Enhance the quality, utility, and
www.reginfo.gov/public/do/ of compensation. See 5 U.S.C. 8132. clarity of the information to be
PRAViewICR?ref_nbr=201504-1240-001 This information collection has been collected; and
(this link will only become active on the classified as a revision, because the
day following publication of this notice) OWCP has updated Form CA–1108 so • Minimize the burden of the
or by contacting Michel Smyth by that it automatically calculates attorney collection of information on those who
telephone at 202–693–4129, TTY 202– fee and court cost information, provides are to respond, including through the
693–8064, (these are not toll-free information about the employee’s net use of appropriate automated,
numbers) or sending an email to DOL_ entitlement, clarifies the instructions, electronic, mechanical, or other
PRA_PUBLIC@dol.gov. and includes the case file number; Form technological collection techniques or
Submit comments about this request CA–1122 has been changed to include other forms of information technology,
by mail or courier to the Office of the case file number and employee’s e.g., permitting electronic submission of
Information and Regulatory Affairs, name. The FECA authorizes this responses.
Attn: OMB Desk Officer for DOL– information collection. See 5 U.S.C. Agency: DOL–OWCP.
OWCP, Office of Management and 8121, 8132, 8149 Title of Collection: Statement of
Budget, Room 10235, 725 17th Street This information collection is subject Recovery Forms.
NW., Washington, DC 20503; by Fax: to the PRA. A Federal agency generally
202–395–5806 (this is not a toll-free OMB Control Number: 1240–0001.
cannot conduct or sponsor a collection
number); or by email: OIRA_ of information, and the public is Affected Public: Individuals or
submission@omb.eop.gov. Commenters generally not required to respond to an Households and Private Sector—
are encouraged, but not required, to information collection, unless it is businesses or other for-profits.
send a courtesy copy of any comments approved by the OMB under the PRA Total Estimated Number of
by mail or courier to the U.S. and displays a currently valid OMB Respondents: 842.
Department of Labor—OASAM, Office Control Number. In addition,
of the Chief Information Officer, Attn: Total Estimated Number of
notwithstanding any other provisions of Responses: 842.
Departmental Information Compliance law, no person shall generally be subject
Management Program, Room N1301, to penalty for failing to comply with a Total Estimated Annual Time Burden:
200 Constitution Avenue NW., collection of information that does not 419.
Washington, DC 20210; or by email: display a valid Control Number. See 5 Total Estimated Annual Other Costs
DOL_PRA_PUBLIC@dol.gov.
tkelley on DSK3SPTVN1PROD with NOTICES

CFR 1320.5(a) and 1320.6. The DOL Burden: $219.
For Further Information: Contact obtains OMB approval for this
Michel Smyth by telephone at 202–693– Dated: August 3, 2015.
information collection under Control
4129, TTY 202–693–8064, (these are not Michel Smyth,
Number 1240–0001. The current
toll-free numbers) or sending an email approval is scheduled to expire on Departmental Clearance Officer.
to DOL_PRA_PUBLIC@dol.gov. August 31, 2015; however, the DOL [FR Doc. 2015–19457 Filed 8–6–15; 8:45 am]
Authority: 44 U.S.C. 3507(a)(1)(D). notes that existing information BILLING CODE 4510–CH–P

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Document Created: 2015-12-15 10:57:03
Document Modified: 2015-12-15 10:57:03

Category		Regulatory Information
Collection		Federal Register
sudoc Class		AE 2.7: GS 4.107: AE 2.106:
Publisher		Office of the Federal Register, National Archives and Records Administration
Section		Notices
Action		Notice.
Dates		The OMB will consider all written comments that agency receives on or before September 8, 2015.
FR Citation		80 FR 47527

80 FR 47527 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Statement of Recovery Forms

DEPARTMENT OF LABOROffice of the Secretary

Federal Register Volume 80, Issue 152 (August 7, 2015)

DEPARTMENT OF LABOR
Office of the Secretary