81 FR 12129 - Proposed Extension of Existing Collections; Comment Request
DEPARTMENT OF LABOR
Office of Workers' Compensation Programs Federal Register Volume 81, Issue 45 (March 8, 2016)
Office of Workers' Compensation Programs
Federal Register Volume 81, Issue 45 (March 8, 2016)
| Page Range | 12129-12130 | |
| FR Document | 2016-05143 |
[Federal Register Volume 81, Number 45 (Tuesday, March 8, 2016)] [Notices] [Pages 12129-12130] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2016-05143] ----------------------------------------------------------------------- DEPARTMENT OF LABOR Office of Workers' Compensation Programs Proposed Extension of Existing Collections; Comment Request AGENCY: Office of Workers' Compensation Programs, Labor. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: The Department of Labor, as part of its continuing effort to reduce paperwork and respondent burden, conducts a preclearance consultation program to provide the general public and Federal agencies with an opportunity to comment on proposed [[Page 12130]] and/or continuing collections of information in accordance with the Paperwork Reduction Act of 1995 (PRA95) [44 U.S.C. 3506(c)(2)(A)]. This program helps to ensure that requested data can be provided in the desired format, reporting burden (time and financial resources) is minimized, collection instruments are clearly understood, and the impact of collection requirements on respondents can be properly assessed. Currently, the Office of Workers' Compensation Programs is soliciting comments concerning the proposed collection: Claim for Compensation by Dependents Information Reports (CA-5, CA-5b, CA-1031, CA-1074, Letter of Compensation Due at Death, and Letter of Student/ Dependency). A copy of the proposed information collection request can be obtained by contacting the office listed below in the addresses section of this Notice. DATES: Written comments must be submitted to the office listed in the ADDRESSES section below on or before May 9, 2016. ADDRESSES: Ms. Yoon Ferguson, U.S. Department of Labor, 200 Constitution Ave. NW., Room S-3323, Washington, DC 20210, telephone/fax (202) 354-9647, Email [email protected]. Please use only one method of transmission for comments (mail, fax, or Email). SUPPLEMENTARY INFORMATION: I. Background The forms included in this package are forms used by Federal employees and their dependents to claim benefits, to prove continued eligibility for benefits, to show entitlement to remaining compensation payments of a deceased employee and to show dependency under the Federal Employees' Compensation Act. There are six items in this information collection request. The information collected by Forms CA- 5, is used by dependents for claiming compensation for the work related death of a Federal Employee and CA-5b is used by other survivors. Form CA-1031 is used in disability cases and provides information to determine whether a claimant is actually supporting a dependent and is entitled to additional compensation. Form CA-1074 is a follow up to CA- 5b to request clarification of any information that is unclear and incomplete in the CA-5b. The letter of ``Compensation Due at Death'' is used to request information necessary to distribute compensation due when an employee dies who was receiving or who was entitled to compensation at the time of death for either disability benefits or a scheduled award. The letter of ``Student/Dependency'' is used to obtain information regarding the student status of a dependent. When a child reaches 18 years of age, they are no longer considered an eligible dependent unless they are a full time student or incapable of self- support. This information collection is currently approved for use through August 31, 2016. II. Review Focus The Department of Labor is particularly interested in comments which: * 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 submissions of responses. III. Current Actions The Department of Labor seeks extension of approval to collect this information in order to carry out its responsibility to meet the statutory requirements of the Federal Employees' Compensation Act. The information contained in these forms is used by the Division of Federal Employees' Compensation to determine entitlement to benefits under the Act, to verify dependent status, and to initiate, continue, adjust, or terminate benefits based on eligibility criteria. Type of Review: Extension. Agency: Office of Workers' Compensation Programs. Title: Claim for Compensation by Dependents Information Reports. OMB Number: 1240-0013. Agency Number: CA-5, CA-5b, CA-1031, CA-1074, Letter of Compensation Due at Death, and Letter of Student/Dependency. Affected Public: Individuals or households. Total Respondents: 1,675. Total Responses: 1,675. ---------------------------------------------------------------------------------------------------------------- Time to Frequency of Number of Form/Letter complete (min) response respondents Hours burden ---------------------------------------------------------------------------------------------------------------- CA-5............................................ 90 1 129 194 CA-5b........................................... 90 1 7 11 CA-1031......................................... 20 1 83 28 CA-1074......................................... 60 1 5 5 Student Dependency.............................. 30 1 1,111 556 Comp Due at Death............................... 30 1 340 170 --------------------------------------------------------------- Totals...................................... .............. .............. 1,675 964 ---------------------------------------------------------------------------------------------------------------- Estimated Total Burden Hours: 964. Total Burden Cost (capital/startup): $0. Total Burden Cost (operating/maintenance): $871. Comments submitted in response to this notice will be summarized and/or included in the request for Office of Management and Budget approval of the information collection request; they will also become a matter of public record. Dated: March 3, 2016. Yoon Ferguson, Agency Clearance Officer, Office of Workers' Compensation Programs U.S. Department of Labor. [FR Doc. 2016-05143 Filed 3-7-16; 8:45 am] BILLING CODE 4510-CH-P
![Federal Register / Vol. 81, No. 45 / Tuesday, March 8, 2016 / Notices 12129
DEPARTMENT OF LABOR SUPPLEMENTARY INFORMATION: This ICR publication of this notice in the Federal
seeks approval under the PRA for Register. In order to help ensure
Office of the Secretary revisions to the Benefit Rights and appropriate consideration, comments
Experience Report, Form ETA–218, should mention OMB Control Number
Agency Information Collection information collection. In order for an 1205–0177. The OMB is particularly
Activities; Submission for OMB individual to be eligible for a State interested in comments that:
Review; Comment Request; Benefit unemployment compensation program, • Evaluate whether the proposed
Rights and Experience Report the claimant must meet certain collection of information is necessary
ACTION: Notice. requirements that demonstrate for the proper performance of the
attachment to the labor force. The vast functions of the agency, including
SUMMARY: The Department of Labor majority of states use past wages for this whether the information will have
(DOL) is submitting the Employment purpose, however, a few States use practical utility;
and Training Administration (ETA) actual weeks of work. A State reports • Evaluate the accuracy of the
sponsored information collection information relative to this first test of agency’s estimate of the burden of the
request (ICR) revision titled, ‘‘Benefit eligibility—known as monetary proposed collection of information,
Rights and Experience Report,’’ to the eligibility—on Form ETA–218, which including the validity of the
Office of Management and Budget includes counts on number of methodology and assumptions used;
(OMB) for review and approval for use individuals who were and were not • Enhance the quality, utility, and
in accordance with the Paperwork monetarily eligible, those eligible for the clarity of the information to be
Reduction Act (PRA) of 1995 (44 U.S.C. maximum benefits, the number of newly collected; and
3501 et seq.). Public comments on the eligible claimants categorized by • Minimize the burden of the
ICR are invited. potential duration, and the number of collection of information on those who
DATES: The OMB will consider all persons who exhausted benefits are to respond, including through the
written comments that agency receives categorized by their actual duration. use of appropriate automated,
on or before April 7, 2016. This information collection has been electronic, mechanical, or other
ADDRESSES: A copy of this ICR with classified as a revision, because the technological collection techniques or
applicable supporting documentation; Extended Unemployment Compensation other forms of information technology,
including a description of the likely program has ended; therefore, e.g., permitting electronic submission of
respondents, proposed frequency of maintaining the related information responses.
response, and estimated total burden collection requirements no longer has Agency: DOL–ETA.
may be obtained free of charge from the practical utility. Social Security Act Title of Collection: Benefit Rights and
RegInfo.gov Web site at http:// section 303(a)(6) authorizes this Experience Report.
www.reginfo.gov/public/do/ information collection. See 42 U.S.C. OMB Control Number: 1205–0177.
PRAViewICR?ref_nbr=201512-1205-002 503(a)(6). Affected Public: State, Local, and
(this link will only become active on the This information collection is subject Tribal Governments.
day following publication of this notice) to the PRA. A Federal agency generally Total Estimated Number of
or by contacting Michel Smyth by cannot conduct or sponsor a collection Respondents: 55.
telephone at 202–693–4129, TTY 202– of information, and the public is Total Estimated Number of
693–8064, (these are not toll-free generally not required to respond to an Responses: 216.
numbers) or sending an email to DOL_ information collection, unless it is Total Estimated Annual Time Burden:
PRA_PUBLIC@dol.gov. approved by the OMB under the PRA 108 hours.
Submit comments about this request and displays a currently valid OMB Total Estimated Annual Other Costs
by mail or courier to the Office of Control Number. In addition, Burden: $0.
Information and Regulatory Affairs, notwithstanding any other provisions of Dated: March 2, 2016.
Attn: OMB Desk Officer for DOL–ETA, law, no person shall generally be subject
Michel Smyth,
Office of Management and Budget, to penalty for failing to comply with a
collection of information that does not Departmental Clearance Officer.
Room 10235, 725 17th Street NW., [FR Doc. 2016–05067 Filed 3–7–16; 8:45 am]
Washington, DC 20503; by Fax: 202– display a valid Control Number. See 5
395–5806 (this is not a toll-free CFR 1320.5(a) and 1320.6. The DOL BILLING CODE 4510–FN–P
number); or by email: OIRA_ obtains OMB approval for this
submission@omb.eop.gov. Commenters information collection under Control
Number 1205–0177. The current DEPARTMENT OF LABOR
are encouraged, but not required, to
send a courtesy copy of any comments approval is scheduled to expire on May
31, 2016; however, the DOL notes that Office of Workers’ Compensation
by mail or courier to the U.S. Programs
Department of Labor—OASAM, Office existing information collection
of the Chief Information Officer, Attn: requirements submitted to the OMB Proposed Extension of Existing
Departmental Information Compliance receive a month-to-month extension Collections; Comment Request
Management Program, Room N1301, while they undergo review. New
requirements would only take effect AGENCY: Office of Workers’
200 Constitution Avenue NW.,
upon OMB approval. For additional Compensation Programs, Labor.
Washington, DC 20210; or by email:
asabaliauskas on DSK3SPTVN1PROD with NOTICES
substantive information about this ICR, ACTION: Notice.
DOL_PRA_PUBLIC@dol.gov.
see the related notice published in the
FOR FURTHER INFORMATION CONTACT: SUMMARY: The Department of Labor, as
Federal Register on September 28, 2015
Contact Michel Smyth by telephone at (80 FR 58299). part of its continuing effort to reduce
202–693–4129, TTY 202–693–8064, Interested parties are encouraged to paperwork and respondent burden,
(these are not toll-free numbers) or send comments to the OMB, Office of conducts a preclearance consultation
sending an email to DOL_PRA_ Information and Regulatory Affairs at program to provide the general public
PUBLIC@dol.gov. the address shown in the ADDRESSES and Federal agencies with an
Authority: 44 U.S.C. 3507(a)(1)(D). section within thirty (30) days of opportunity to comment on proposed
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![12130 Federal Register / Vol. 81, No. 45 / Tuesday, March 8, 2016 / Notices
and/or continuing collections of deceased employee and to show * evaluate the accuracy of the
information in accordance with the dependency under the Federal agency’s estimate of the burden of the
Paperwork Reduction Act of 1995 Employees’ Compensation Act. There proposed collection of information,
(PRA95) [44 U.S.C. 3506(c)(2)(A)]. This are six items in this information including the validity of the
program helps to ensure that requested collection request. The information methodology and assumptions used;
data can be provided in the desired collected by Forms CA–5, is used by * enhance the quality, utility and
format, reporting burden (time and dependents for claiming compensation clarity of the information to be
financial resources) is minimized, for the work related death of a Federal collected; and
collection instruments are clearly Employee and CA–5b is used by other * minimize the burden of the
understood, and the impact of collection survivors. Form CA–1031 is used in collection of information on those who
requirements on respondents can be disability cases and provides are to respond, including through the
properly assessed. Currently, the Office information to determine whether a use of appropriate automated,
of Workers’ Compensation Programs is claimant is actually supporting a electronic, mechanical, or other
soliciting comments concerning the dependent and is entitled to additional technological collection techniques or
proposed collection: Claim for compensation. Form CA–1074 is a other forms of information technology,
Compensation by Dependents follow up to CA–5b to request e.g., permitting electronic submissions
Information Reports (CA–5, CA–5b, CA– clarification of any information that is of responses.
1031, CA–1074, Letter of Compensation unclear and incomplete in the CA–5b.
III. Current Actions
Due at Death, and Letter of Student/ The letter of ‘‘Compensation Due at
Dependency). A copy of the proposed Death’’ is used to request information The Department of Labor seeks
information collection request can be necessary to distribute compensation extension of approval to collect this
obtained by contacting the office listed due when an employee dies who was information in order to carry out its
below in the addresses section of this receiving or who was entitled to responsibility to meet the statutory
Notice. compensation at the time of death for requirements of the Federal Employees’
either disability benefits or a scheduled Compensation Act. The information
DATES: Written comments must be contained in these forms is used by the
award. The letter of ‘‘Student/
submitted to the office listed in the Division of Federal Employees’
Dependency’’ is used to obtain
ADDRESSES section below on or before
information regarding the student status Compensation to determine entitlement
May 9, 2016. to benefits under the Act, to verify
of a dependent. When a child reaches 18
ADDRESSES: Ms. Yoon Ferguson, U.S. years of age, they are no longer dependent status, and to initiate,
Department of Labor, 200 Constitution considered an eligible dependent unless continue, adjust, or terminate benefits
Ave. NW., Room S–3323, Washington, they are a full time student or incapable based on eligibility criteria.
DC 20210, telephone/fax (202) 354– of self-support. This information Type of Review: Extension.
9647, Email ferguson.yoon@dol.gov. collection is currently approved for use Agency: Office of Workers’
Please use only one method of through August 31, 2016. Compensation Programs.
transmission for comments (mail, fax, or Title: Claim for Compensation by
Email). II. Review Focus Dependents Information Reports.
SUPPLEMENTARY INFORMATION: The Department of Labor is OMB Number: 1240–0013.
particularly interested in comments Agency Number: CA–5, CA–5b, CA–
I. Background which: 1031, CA–1074, Letter of Compensation
The forms included in this package * Evaluate whether the proposed Due at Death, and Letter of Student/
are forms used by Federal employees collection of information is necessary Dependency.
and their dependents to claim benefits, for the proper performance of the Affected Public: Individuals or
to prove continued eligibility for functions of the agency, including households.
benefits, to show entitlement to whether the information will have Total Respondents: 1,675.
remaining compensation payments of a practical utility; Total Responses: 1,675.
Time to Frequency of Number of
Form/Letter complete Hours burden
response respondents
(min)
CA–5 ................................................................................................................ 90 1 129 194
CA–5b .............................................................................................................. 90 1 7 11
CA–1031 .......................................................................................................... 20 1 83 28
CA–1074 .......................................................................................................... 60 1 5 5
Student Dependency ....................................................................................... 30 1 1,111 556
Comp Due at Death ......................................................................................... 30 1 340 170
Totals ........................................................................................................ ........................ ........................ 1,675 964
asabaliauskas on DSK3SPTVN1PROD with NOTICES
Estimated Total Burden Hours: 964. Management and Budget approval of the Dated: March 3, 2016.
Total Burden Cost (capital/startup): information collection request; they will Yoon Ferguson,
$0. also become a matter of public record. Agency Clearance Officer, Office of Workers’
Total Burden Cost (operating/ Compensation Programs U.S. Department of
maintenance): $871. Labor.
Comments submitted in response to [FR Doc. 2016–05143 Filed 3–7–16; 8:45 am]
this notice will be summarized and/or BILLING CODE 4510–CH–P
included in the request for Office of
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Document Created: 2018-02-02 15:10:27
Document Modified: 2018-02-02 15:10:27
| 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 | Written comments must be submitted to the office listed in the | |
| FR Citation | 81 FR 12129 |
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