82_FR_45806 82 FR 45618 - Request for Information on Potential Stay-at-Work/Return-to-Work Demonstration Projects

82 FR 45618 - Request for Information on Potential Stay-at-Work/Return-to-Work Demonstration Projects

DEPARTMENT OF LABOR

Federal Register Volume 82, Issue 188 (September 29, 2017)

Page Range45618-45623
FR Document2017-20338

Washington State's workers' compensation system runs several promising early intervention programs including the Centers of Occupational Health and Education (COHE) and the Early Return to Work and the Stay at Work programs, which provide early intervention and return-to-work services for individuals with work-related health conditions and their employers. The President's FY2018 budget proposed that the Office of Disability Employment Policy (ODEP) at the U.S. Department of Labor (DOL) and the Social Security Administration (SSA) jointly conduct a demonstration testing the effects of implementing key features of these programs in other states and/or for a broader population beyond workers' compensation. To do that, we anticipate funding two to three states to operate projects with key elements drawn from the Washington State programs mentioned above, with an increased emphasis on access to employment-related supports, or fund the expansion of existing programs to include increased access to employment-related supports. The ultimate policy goal is to increase employment and labor force participation of individuals who have or are developing work disabilities. This request for information (RFI) seeks public input on how the proposed demonstration projects can best be designed to promote labor force attachment, coordinate employment and health services, and support injured and ill workers in returning to and remaining at work. The input we receive will inform our deliberations about the possible design of a future demonstration project.

Federal Register, Volume 82 Issue 188 (Friday, September 29, 2017)
[Federal Register Volume 82, Number 188 (Friday, September 29, 2017)]
[Notices]
[Pages 45618-45623]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-20338]


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DEPARTMENT OF LABOR

[Agency Docket Number: DOL-2017-0003]


Request for Information on Potential Stay-at-Work/Return-to-Work 
Demonstration Projects

AGENCY: Office of Disability Employment Policy, DOL.

ACTION: Request for information.

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SUMMARY: Washington State's workers' compensation system runs several 
promising early intervention programs including the Centers of 
Occupational Health and Education (COHE) and the Early Return to Work 
and the Stay at Work programs, which provide early intervention and 
return-to-work services for individuals with work-related health 
conditions and their employers. The President's FY2018 budget proposed 
that the Office of Disability Employment Policy (ODEP) at the U.S. 
Department of Labor (DOL) and the Social Security Administration (SSA) 
jointly conduct a demonstration testing the effects of implementing key 
features of these programs in other states and/or for a broader 
population beyond workers' compensation. To do that, we anticipate 
funding two to three states to operate projects with key elements drawn 
from the Washington State programs mentioned above, with an increased 
emphasis on access to employment-related supports, or fund the 
expansion of existing programs to include increased access to 
employment-related supports. The ultimate policy goal is to increase 
employment and labor force participation of individuals who have or are 
developing work disabilities. This request for information (RFI) seeks 
public input on how the proposed demonstration projects can best be 
designed to promote labor force attachment, coordinate employment and 
health services, and support injured and ill workers in returning to 
and remaining at work. The input we receive will inform our 
deliberations about the possible design of a future demonstration 
project.

DATES: Comments must be received by October 30, 2017.

ADDRESSES: You may submit comments by any one of three methods--
Internet, fax, or mail. Do not submit the same comments multiple times 
or by more than one method. Regardless of which method you choose, 
please refer to Docket No. DOL-2017-0003in your comment pages so that 
we may associate your comments with the correct docket.
    Caution: In your comments, you should be careful to include only 
the information that you wish to make publicly available. We strongly 
urge you not to include in your comments any personal information, such 
as Social Security numbers or medical information.
    1. Internet: We strongly recommend that you submit your comments 
via the Internet. Please visit the Federal eRulemaking portal at http://www.regulations.gov. Use the ``Search'' function to find docket number 
DOL-2017-0003. The system will issue a tracking number to confirm your 
submission. You will not be able to view your comment immediately 
because we must post each comment manually. It may take up to a week 
for your comment to be viewable.
    2. Fax: Fax comments to (202) 693-7888.
    3. Mail: Mail your comments to the Office of Disability Employment 
Policy, U.S. Department of Labor, 200 Constitution Avenue NW., S-1303, 
Washington, DC 20210.
    Comments are available for public viewing on the Federal 
eRulemaking portal at http://www.regulations.gov or in person, during 
regular business

[[Page 45619]]

hours, by arranging with the contact person identified below.

FOR FURTHER INFORMATION CONTACT: Jennifer Sheehy, Deputy Assistant 
Secretary, Office of Disability Employment Policy, U.S. Department of 
Labor, 200 Constitution Avenue NW., S-1303, Washington, DC 20210, (202) 
693-7880, or visit https://www.dol.gov/dol/contact/contact-phonecallcenter.htm (TTY), for information about this notice.

SUPPLEMENTARY INFORMATION: 

Purpose

    Millions of American workers leave the workforce each year after 
experiencing an injury or illness.\1\ Hundreds of thousands of these 
workers go on to receive state or Federal disability benefits.\2\ Many 
injured or ill workers could remain in their jobs or the workforce if 
they received timely, effective supports.
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    \1\ Bardos, Maura, Hannah Burak, and Yonatan Ben-Shalom. 
``Assessing the Costs and Benefits of Return-to-Work Programs.'' 
Final report submitted to the U.S. Department of Labor, Office of 
Disability Employment Policy. Washington, DC: Mathematica Policy 
Research, March 2015.
    \2\ Social Security Administration, ``Annual Statistical Report 
on the Social Security Disability Insurance Program, 2015.'' SSA 
Publication No. 13-11826. Washington, DC: Social Security 
Administration, October 2016.
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    This request for information (RFI) offers interested parties--
including but not limited to states, community-based and other non-
profit organizations, philanthropic organizations, researchers, 
employers, health care providers with assorted training and 
specialties, private disability insurance providers, vocational 
rehabilitation specialists, and members of the public--the opportunity 
to provide information and recommendations to inform the development of 
a potential grant program aimed at reducing long-term disability and 
increasing labor force participation among workers who are injured or 
become ill while employed.

Background

    The President's 2018 budget supports a demonstration to test 
promising Stay-at-Work/Return-to-Work (SAW/RTW) strategies aimed at 
improving labor force participation, employment, and earnings outcomes 
for workers who are injured or become ill.
    The proposed demonstration program is modeled after promising 
programs in Washington State including the Centers for Occupational 
Health and Education (COHE) \3\ and the Early Return to Work \4\ (ERTW) 
and Stay at Work programs.\5\ Projects funded through the proposed 
demonstration project, however, would include additional connections to 
existing employment services and supports provided through the 
workforce development system.
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    \3\ http://www.lni.wa.gov/ClaimsIns/Providers/ProjResearchComm/OHS/default.asp.
    \4\ http://www.lni.wa.gov/ClaimsIns/Insurance/Injury/LightDuty/Ertw/Default.asp.
    \5\ http://lni.wa.gov/Main/StayAtWork/.
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    COHE, which is funded by Washington's workers' compensation system, 
provides early intervention and RTW services for individuals with work-
related health conditions. An evaluation of the COHE pilot in the early 
2000s produced promising results: COHE participants were less likely to 
be off work and on disability benefits one year after the claim, and 
combined medical and disability costs were reduced by $510 per claim 
for COHE participants. The magnitude of these reductions was greater 
for back sprain cases (a common occupational injury): the relative risk 
of being off work and on disability at one year was 37 percent lower 
for back sprain COHE patients, and disability costs for back sprains 
were reduced by $542 per case.\6\ Preliminary analysis indicated that 
at the eight-year mark, 26 percent fewer COHE claimants received Social 
Security Disability Insurance (SSDI) benefits.\7\
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    \6\ Wickizer, T.M., Franklin, G., Fulton-Kehoe, D., Gluck, J., 
Mootz, R., Smith-Weller, T., and Plaeger-Brockway, R. (2011) 
``Improving Quality, Preventing Disability and Reducing Costs in 
Workers' Compensation Healthcare: A Population-based Intervention 
Study.'' Medical Care, Vol. 49, No. 12, pp. 1105-1111.
    \7\ Franklin, G.M., Wickizer, T.M., Coe, N.B, and Fulton-Kehoe, 
D. (2015) ``Workers' Compensation: Poor Quality Health Care and the 
Growing Disability Problem in the United States.'' American Journal 
of Industrial Medicine, 58: 245-251.
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    The ERTW program and Stay at Work programs in Washington State 
provide related assistance. The ERTW program helps injured and ill 
workers RTW as soon as medically possible by providing access to a team 
of vocational services consultants, therapists, and nurse consultants 
to assist with developing and implementing medically appropriate RTW 
options. The Stay at Work program is a financial incentive program that 
reimburses employers for some of their costs when providing temporary, 
light-duty jobs for injured workers while they heal.
    This demonstration will draw from and test key features of the 
Washington COHE model and ERTW and Stay at Work programs, in other 
states and/or for a population beyond workers' compensation (i.e., for 
non-occupational injuries and illnesses). To do that, we anticipate 
funding states to operate one or more COHE-style programs, or fund the 
expansion of existing programs, with an increased emphasis on access to 
employment-related supports. The ultimate policy goal is to increase 
employment and labor force participation of individuals with work 
disabilities, and to identify and/or confirm effective strategies for 
doing so. For the purposes of this RFI, the term ``work disability'' is 
defined as an illness, injury, or medical condition that is anticipated 
to inhibit or prevent continued employment or labor force 
participation.
    This RFI offers interested parties the opportunity to provide 
recommendations on effective approaches for the design and 
implementation of the demonstration project. We expect that public 
input provided in response to this request will assist us in defining 
the scope and design of the demonstration project. For example, a 
demonstration project could test whether elements of the COHE workers' 
compensation model, which focus on immediate or early intervention, 
could be combined with re-employment services provided through the 
American Job Centers for the subset of participants who do not return 
to work within 90 days so that they could obtain additional employment 
services and supports to maintain a workforce attachment. The RFI 
specifically seeks public input on how the proposed demonstration 
projects can best be designed to promote labor force attachment, 
coordinate employment and health services, and support injured and ill 
workers in returning to and remaining at work.
    Background on the COHE model and Early Return to Work and Stay at 
Work programs:
    As the proposed demonstration is based on elements from Washington 
State's COHE, ERTW, and Stay at Work programs, the following background 
material is provided about these programs. There are six COHE centers 
across the state of Washington, including some housed in large medical 
systems and others that are community-based. Each of these centers \8\ 
recruits and trains health care providers in their area--often 
orthopedists or other doctors specializing in treating workers' 
compensation (WC) patients. COHE started as a small pilot in two 
regions and has grown to currently include about 3,500 health care 
providers who cover about 60 percent of all WC claims in the state. 
Injured workers retain health care provider choice. They

[[Page 45620]]

receive COHE services if they choose a COHE-affiliated provider for 
their care.
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    \8\ Grantees will not be required to establish a ``center'' or 
new entity as part of the demonstration.
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    Given that health care providers often see relatively few patients 
who are at risk of labor force separation due to their illness or 
injury, many may have limited knowledge and resources to address the 
employment-related needs of this population. Health care providers 
affiliated with COHE, however, receive training in occupational health 
best practices for these cases, including the following four best 
practices:
    1. Submitting a complete Report of Accident (ROA) in two business 
days or less;
    2. Developing an activity plan, which communicates the worker's 
ability to participate in work activities, activity restrictions, and 
the provider's treatment plans;
    3. Communicating directly with employers when injured workers are 
absent or expected to be absent from work; and
    4. Assessing the injured worker's barriers to return to work and 
developing a plan to overcome them.
    Health service coordinators are integral to the success of the COHE 
model. The program is based on the MacColl chronic care model.\9\ 
Successful health service coordinators are skilled in vocational 
rehabilitation and motivational interviewing and work directly with 
injured workers, employers, health care providers, and other 
stakeholders to coordinate care and RTW activities for injured workers. 
They also help stakeholders navigate the workers' compensation system 
by performing claim coordination functions, such as ensuring forms are 
received and complete and contacting stakeholders as needed for 
clarifications or follow-up. Health service coordinators frequently 
contact injured workers, employers, health care providers, state agency 
staff, and other stakeholders to help with the RTW process, and 
identify barriers to returning to work and resources to resolve them. 
The RTW activities they coordinate for the patient can include 
functional assessments, referrals to existing training and employment 
services, and setting appropriate RTW expectations. Health service 
coordinators also educate employers on the financial and other benefits 
of retaining injured workers and can refer employers to the ERTW and 
Stay at Work programs for resources and financial incentives to help 
them with job accommodation. The health service coordinators monitor 
all cases, but focus on those at risk for long-term disability, 
typically less than a quarter of all cases. The health service 
coordinator role is critical and depends heavily on the neutrality of 
health service coordinators in helping the health care and RTW system 
work effectively for patients, employers, health care providers, and 
the insurer. This neutrality allows health service coordinators to be 
trusted by the various stakeholders, allowing health service 
coordinators to maximize the likelihood of the best-case recovery and 
employment outcome.
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    \9\ See http://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s=2.
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    As a program based in the medical system, COHE depends heavily on 
project champions among sponsoring health care organizations' 
leadership to create organizational buy-in and support. Additionally, 
each COHE participates in a Regional Business-Labor Advisory Board that 
ensures community support and solicits input from local business and 
labor interests.
    Key features of the COHE model of interest to the proposed 
demonstration include:
    1. Coordination of services, including enhanced stakeholder 
communication, RTW planning, and identification of potential delays and 
solutions to keep treatment and RTW plans on track;
    2. Physician training on occupational health best practices;
    3. Incentives for physicians to utilize the best practices for 
participating patients;
    4. A data management system allowing services coordinators real-
time access to all relevant information on each case to support 
effective triage, population monitoring, and case management.
    The ERTW program helps injured and ill workers RTW as soon as 
medically possible by providing access to a team of specialists 
including vocational services consultants, therapist consultants, and 
nurse consultants who assist health care providers and employers 
develop and implement medically appropriate RTW options. Resources 
available to employers include risk management specialists, safety 
consultants to provide on-site consultations, and job modification 
funds. By providing these resources, the ERTW program speeds the 
worker's recovery and reduces the financial impact of a workers' 
compensation claim on the worker, the employer, and the workers' 
compensation system.
    The Stay at Work program incentivizes employers to offer temporary 
light-duty work to injured employees while they heal, by reimbursing 
the employers for some of the costs of providing such jobs. Eligible 
employers can be reimbursed for 50 percent of the base wages they pay 
the injured worker and some of the cost of training, tools, or clothing 
the worker needs to do the light-duty or transitional work.
    The COHE model focuses services on the first 12 weeks after injury 
because this period is most critical in maximizing the likelihood of 
RTW. While the proposed demonstration builds upon the COHE model and 
the ERTW and Stay at Work programs, it differs from the original model 
by adding an extended focus on employment services and supports and a 
strong and purposeful involvement of the workforce development system.

Potential Project Scope

    DOL and SSA anticipate three acquisitions for this project: 
Implementation grants awarded via a cooperative agreement, a technical 
assistance contract to support grantees, and an evaluation contract. 
The agencies anticipate implementing the demonstration in two to three 
states representing diverse programmatic contexts and with the ability 
to provide meaningful analyses and policy recommendations. There would 
be a separate technical assistance (TA) contract to assist states with 
implementation and a separate integrated evaluation contract to 
evaluate all of the sites and address specific research goals. For the 
purposes of this RFI, the implementation grantees are referred to as 
the ``projects,'' the technical assistance contractor is referred to as 
the ``TA provider,'' and the evaluation contractor is referred to as 
the ``evaluator.''
    We anticipate designing this demonstration to solicit innovative 
projects that create systems changes by targeting individuals when they 
are in the early stages of developing a work disability, and assisting 
them in maintaining a connection to the labor force, preferably through 
their current or most recent employer. Projects will be encouraged to 
build upon existing programs or systems, such as state-based temporary 
disability insurance (TDI) programs, collaborative health care 
organizations, disability management insurance providers, or workers' 
compensation programs. We would also encourage projects to think 
broadly about new and effective ways to prevent the development of 
long-term work disability. The solicitation will leave flexibility for 
applicants to develop their own projects that adapt to the specific 
programmatic, demographic, and economic contexts of their state or 
region while also satisfying the project's requirements.

[[Page 45621]]

    Preliminary required design elements of the demonstration are 
described below. We encourage public input and comment on these 
elements in response to the questions in the following section.
    Overview: We anticipate funding implementation grants in two to 
three states to either operate one or more projects with key elements 
drawn from the COHE model and the ERTW and Stay at Work programs, with 
an added emphasis on access to employment-related services and 
supports, or the expansion of similar existing programs to include 
increased access to employment-related supports and services. The 
ultimate policy goal is to increase employment and labor force 
participation of individuals with work disabilities through timely and 
effective coordination of health care and employment-related services. 
Each grantee would be responsible for identifying, recruiting, and 
training health care providers within their geographic area, and 
incentivizing their use of occupational health best practices for 
eligible workers. In addition, each grantee would be responsible for 
providing and supporting return to work service coordinators who will 
coordinate and facilitate the RTW process for eligible workers. 
Grantees would also be responsible for providing a centralized data 
collection and reporting system for the efficient management of the 
care and RTW coordination system, and to support the evaluation of the 
program.
    We anticipate requiring funded projects to include the following 
treatment elements:
     Coordination of services, including enhanced stakeholder 
communication, RTW planning, and identification of potential delays and 
solutions to keep treatment and RTW plans on track;
     Health care provider training on occupational health best 
practices that COHE uses;
     Incentives for health care providers to utilize the 
specified best practices for participating patients;
     Possible incentives for employers to actively participate 
in worker retention and other RTW efforts through utilization of 
strategies such as temporary light-duty jobs, job modifications, and 
job-banking;
     Provision of, or facilitated access to, employment-related 
services and supports (such as needs assessments, skill assessments, 
accommodations, job coaching, job search assistance if not remaining 
with original employer) and training;
     Engaging key stakeholders (e.g., the business community, 
labor representatives) up front and on an ongoing basis; and
     A data management system that:
    [cir] (1) allows service coordinators real-time access to all 
relevant information on each case for purposes of triage, individual 
case management, and population health monitoring, including on 
disability time loss duration; and
    [cir] (2) supports the evaluation of the project.
    Eligible grant applicants: We anticipate requiring each project and 
application to have a state agency designated as the lead coordinating 
entity. The lead agency would be required or encouraged to form 
partnerships with other public or private organizations, such as DOL-
funded employment-service providers, state vocational rehabilitation 
agencies, private non-profit organizations, health care providers/
organizations, other public or private organizations, state and local 
Workforce Investment Boards, and county or municipal-level governments 
as appropriate.
    Population: Each project would be required to identify and clearly 
define its target population, including showing that the population has 
a substantial risk of developing a long-term work disability, and/or 
transitioning to Social Security Disability Insurance (SSDI) or 
Supplemental Security Income (SSI), such that the intervention could 
change their employment outcomes. Projects are encouraged to include 
workers with active state TDI or workers' compensation claims, or those 
using paid leave, as well as broader populations of workers 
experiencing the onset of a medical condition that could result in a 
work disability. The target population must be clearly identifiable 
using existing administrative records, easily completed screening 
forms, or an information management system, and there must be a clear 
mechanism that triggers the start of services.
    Participant Recruitment: Each grantee would propose a recruitment 
plan for outreach and enrollment of worker participants based on their 
target population and their project design. Grantees would be required 
to be able to recruit a sufficient number of worker participants to 
allow for a meaningful assessment of the impact of the intervention. 
Applicants would also be required to recruit and have signed MOUs or 
letters of intent with project partners, including partnering health 
care providers.
    Evaluation Design: We anticipate carrying out an impact and 
implementation study to understand how the programs are implemented, 
service components, who is being served, the extent to which those 
served experience improved outcomes (including labor market outcomes, 
receipt of SSDI/SSI), and a cost-benefit analysis. The impact study 
would include a process evaluation and participation analysis in order 
to assess the implementation and fidelity of the program and general 
interest and take-up rates across the project sites. The evaluation 
design would be finalized once the evaluator is secured and would take 
into account the specifics of the funded projects. All projects would 
be required to fully cooperate with and participate in the evaluation.
    Data collection: Projects would be required to provide for 
centralized data collection to capture care management, RTW 
coordination information, and measures and outcomes of interest to the 
evaluation. The evaluation contractor would be provided access to this 
data. A data management system would be required to allow the service 
coordinators and others in the intervention to have real-time access to 
all relevant information on each case in order to effectively triage, 
monitor, and intervene as needed on a timely basis. Projects would be 
encouraged to use or adapt existing centralized data systems.
    Evaluation: We anticipate evaluating projects on two primary 
research questions:
     Does the intervention improve employment outcomes compared 
to the control group?
     Does the intervention reduce application to Social 
Security Disability Insurance (SSDI) or Supplemental Security Income 
(SSI)?
    Below are additional research questions of interest, which may not 
all be answered by the initial evaluation of the proposed 
demonstration:
     Does the intervention increase labor force participation 
of participating workers?
     Does the intervention increase labor force attachment of 
participating workers?
     Does the intervention reduce labor force exit of 
participating workers?
     Does the intervention maintain or result in increased 
wages of participating workers?
     Does the intervention improve the ability of participating 
workers to maintain hours of work?
     Does the intervention reduce medical, time lost, or 
litigation costs?
     What are optimal and efficient methods to identify target 
populations at risk of exiting the labor force that will benefits from 
the intervention?
     What is the best timing to engage a worker effectively 
while also minimizing cost?

[[Page 45622]]

     What recruitment methods are most effective to engage a 
target population?
     Does the intervention decrease SSDI or SSI allowance 
rates?
     What elements of the intervention are most influential in 
determining success (i.e., improved employment outcomes and reduced 
need for SSDI or SSI benefits)?
     What environmental factors are necessary for successful 
implementation of the intervention?
     What are the cost effective and efficient interventions 
that reduce workers exit from the labor force?
     What are the effective and efficient strategies to 
incentivize employers to actively retain workers with injuries and 
health conditions?
     What are effective and efficient strategies to create buy-
in from health care providers that work is an important health care 
outcome?

Request for Information

    This request for information (RFI) seeks public input on how the 
proposed demonstration projects can best be designed to promote labor 
force attachment, coordinate employment and health services, and 
support injured and ill workers in returning to and remaining at work. 
Through this notice, we are soliciting feedback from interested parties 
on the scope and design of a potential demonstration project related to 
providing coordinated occupational health and employment services to 
individuals who become injured or ill while employed in order to enable 
them to remain in the labor force, thereby improving their employment 
and earnings outcomes and maximizing their self-sufficiency. Responses 
to this request will inform decisions about the development, design, 
and evaluation of the potential demonstration project.
    This notice is for internal planning purposes only and should not 
be construed as a solicitation or as an obligation on the part of the 
Department of Labor or any participating Federal agencies. We ask 
respondents to address the following questions, where possible, in the 
context of the discussion in this document. You do not need to address 
every question and should focus on those that relate to your expertise 
or perspectives. To the extent possible, please clearly indicate which 
question(s) you address in your response. We ask that each respondent 
include the name and address of his or her institution or affiliation, 
if any, and the name, title, mailing and email addresses, and telephone 
number of a contact person for his or her institution or affiliation, 
if any.

Questions

I. Intervention Elements

    1. Are there potential issues with the treatment elements listed 
under ``required treatment elements'' on pages 6-7? Should any not be 
required? What other elements might be useful, and what is the evidence 
base for them? What additional optional services and supports could 
grantees choose to include in the model? What is the existing evidence 
documenting the effectiveness of these additional optional services and 
supports?
    2. What should be the required and optional roles and 
responsibilities of the RTW service coordinator in implementing the 
treatment elements?
    3. Where should the role of a RTW service coordinator be housed in 
order to most effectively accomplish its goals, including an ability to 
maintain neutrality? For example, should service coordinators be 
employed by health care provider networks, by the public workforce 
system, by private disability insurance providers, by employers, or by 
another entity?
    4. Should there be educational and/or experience requirements for 
the RTW service coordinators, such as vocational counseling or public 
health backgrounds? How should these educational and experience 
requirements parallel and differ from those of health navigators, 
community health workers, and vocational rehabilitation counselors?
    5. What specific employment-related interventions should be 
required or allowed? What evidence supports these interventions as 
effective in early intervention for these populations? When referrals 
to existing employment-related service providers occur, will these 
providers have sufficient capacity and funding to provide services in a 
timely manner to referred individuals?
    6. The COHE model focuses interventions primarily in the first 12 
weeks after injury/illness (with occasional exceptions allowing up to 
26 weeks). For a demonstration such as this requiring increased 
involvement of the workforce development system, what is the optimal 
timing and length of intervention? Why, or what is the evidence base?
    7. Employment services (such as needs assessments, skill 
assessments, accommodations, job coaching, job search assistance if not 
remaining with original employer) and the public workforce system are 
important elements of the proposed demonstration program. What is the 
optimal time to provide employment services? For example, should 
employment services be provided during the same time window as the 
health care services/coordination, or afterwards? How can the RTW 
service coordinators best facilitate the effective use of employment 
services?
    8. What role should employer incentives play in this intervention? 
Are there particular employer incentives that we should consider in 
projects where workers' compensation insurance premiums play a limited 
role? Are there effective non-financial ways to engage and incentivize 
employers to support and implement SAW/RTW programs within their 
workplaces?
    9. What is an appropriate health care provider payment or fee 
structure to incentivize the specific occupational health best 
practices and to encourage a focus on employment as a health outcome? 
Are there models other than fee-for-service that would be appropriate 
and feasible, such as basing payments on process and/or outcome 
metrics? How would these models operate in the context of managed-care 
organizations?
    10. How can health systems and health care providers be better 
incentivized to consider employment a valid health outcome? What is the 
recent relevant evidence documenting the effectiveness of incentive 
models (including financial or other incentives) that include 
employment as an outcome?

II. Target Population and Sites

    11. What is an appropriate age range of participants to target for 
this demonstration project? For example, should the demonstration 
projects target prime-age workers (25-54)? Why or why not?
    12. What populations of RTW participants--such as those listed 
below--should be allowed, encouraged, or required in the demonstration? 
Why should the populations you recommend be included? Are there 
populations of RTW participants that you would not recommend?
    [ssquf] Individuals with active state-based TDI claims?
    [ssquf] Workers accessing FMLA benefits (except for pregnancy and 
caring for others)?
    [ssquf] Individuals with active WC claims?
    [ssquf] Others (not participating in WC or TDI) experiencing the 
onset of a medical condition that could affect their connection to the 
workforce?
    13. How should the target population described above be 
specifically defined and cleanly identified? We are particularly 
interested in how to define an appropriate population that is not 
limited to individuals with state-based

[[Page 45623]]

TDI claims or WC. What are the most appropriate eligibility criteria 
(such as time off work, type of condition, type of employment) to 
identify such individuals? What kinds of ``triggers'' would work for 
the population as a mechanism for enrollment into the project?
    14. Are there specific functional risk assessment instruments that 
you recommend using for this project? What are the benefits and 
limitations of those instruments? How might they be used to identify 
the target population here or form the basis for an RTW plan?
    15. Are there aspects of your state's TDI, paid leave, FMLA, WC, or 
other state programs that would pose particular advantages or 
challenges for identifying workers who might benefit from an 
intervention like the one discussed above? Are there aspects of these 
programs that would pose particular advantages or challenges for 
collecting data on treatments, services, and outcomes for a project 
like this?
    16. Should the target population be limited to individuals with 
certain types of medical conditions, such as musculoskeletal conditions 
and chronic health conditions? Why or why not?
    17. How should project service areas be defined? For example, 
should demonstrations be carried out state-wide, in specific counties, 
regions, or local communities? Would these service areas have a large 
enough target population for evaluation purposes?
    18. What types of entities would be the most beneficial to consider 
partnering with to provide the COHE-style services, and why? Examples 
could include large health-care systems, collections of small health 
care provider offices, private self-insured employers with in-house 
disability management, vocational rehabilitation providers, accountable 
or managed care organizations, federally qualified community health 
centers, community based organizations, and urgent care centers.

III. Eligible Applicants

    19. What types of state government entities are the most logical or 
well-positioned to serve as the primary applicant and fiscal agent? 
What is the best way to organize the structure of a demonstration like 
the one described above in your state? What structure would best enable 
effective leadership, responsibility, and accountability for the 
project? Would a single agency be the natural lead for the project?
    20. Similar state functions may be housed in different agencies, 
depending on the state. Should key functions be required, rather than 
specific agencies? If so, what functions should be required?
    21. Should groups of states be allowed to jointly apply? Why or why 
not?
    22. Could a non-state (i.e., county or local government) or non-
governmental (i.e., non-profit or private organization) entity serve as 
the primary applicant and fiscal agent? If so, what characteristics 
should be required of such entities? Would this be preferable to a 
state governmental agency serving in this role? Why or why not?
    23. The COHE model in Washington operates within a monopolistic WC 
system, which allows for centralized participant controls, service 
management, and data collection. Would states with other WC models, 
such as privately managed and competitive WC markets, be able to 
feasibly implement a similar model, particularly with regard to data 
collection? If so, how? Would states with short-term or temporary 
disability insurance programs or states with mandatory paid sick leave 
be able to do so, and how? In other words, should grant applicants be 
limited to states with specific characteristics, and why or why not?
    24. What partners, public or private, should be required or 
encouraged as part of the demonstration project? What other entities 
might be beneficial as collaborators? In what ways could they assist?

IV. Evaluation and Design Issues

    25. Are there research questions, not specified above, that could 
be answered through the evaluation which would improve understanding of 
ways to better serve and increase employment and labor force 
participation of individuals with work disabilities?
    26. What entity would be most successful in recruiting participants 
who have a qualifying injury or health condition (that makes them at 
risk for leaving the labor force)? Examples could include an insurance 
company, state TDI or WC insurance providers, an employer, or a health 
care provider.
    27. Do health systems and/or health care providers utilize risk 
predictors to target specific types of services? If so, which 
predictors are used, and for which services? Are any employment- or 
SAW/RTW-related?
    28. If a cluster-randomized design is used for an experimental 
impact evaluation, how could the unit of randomization be defined and 
operationalized within various types of grantee sites? Are there other 
evaluation designs (randomized or not) that would be more feasible 
(e.g. quasi-experimental design)? If so, how could a potential 
comparison group be identified? If other randomized designs are 
recommended, what are potential units for random assignment and points 
at which assignment would occur?

Rights to Materials Submitted

    By submitting material in response to this notice, you agree to 
grant us a worldwide, royalty-free, perpetual, irrevocable, 
nonexclusive license to use the material, and to post it publicly. 
Further, you agree that you own, have a valid license, or are otherwise 
authorized to provide the material to us. You should not provide any 
material you consider confidential or proprietary in response to this 
notice. We will not provide any compensation for material submitted in 
response to this notice.

Jennifer Sheehy,
Deputy Assistant Secretary for Disability Employment Policy.
[FR Doc. 2017-20338 Filed 9-28-17; 8:45 am]
 BILLING CODE P



                                                    45618                       Federal Register / Vol. 82, No. 188 / Friday, September 29, 2017 / Notices

                                                    plan fiduciaries, participants, and the                   • Enhance the quality, utility, and                 compensation. To do that, we anticipate
                                                    DOL and Internal Revenue Service to                     clarity of the information to be                      funding two to three states to operate
                                                    determine whether the conditions of the                 collected; and                                        projects with key elements drawn from
                                                    exemption have been met for a period                      • Minimize the burden of the                        the Washington State programs
                                                    of six years from the date of execution                 collection of information on those who                mentioned above, with an increased
                                                    of a transaction. Internal Revenue Code                 are to respond, including through the                 emphasis on access to employment-
                                                    of 1986 section 4975 and ERISA section                  use of appropriate automated,                         related supports, or fund the expansion
                                                    408 authorize this information                          electronic, mechanical, or other                      of existing programs to include
                                                    collection. See 26 U.S.C. 4975; 29 U.S.C.               technological collection techniques or                increased access to employment-related
                                                    1108.                                                   other forms of information technology,                supports. The ultimate policy goal is to
                                                      This information collection is subject                e.g., permitting electronic submission of             increase employment and labor force
                                                    to the PRA. A Federal agency generally                  responses.                                            participation of individuals who have or
                                                    cannot conduct or sponsor a collection                    Agency: DOL–EBSA.                                   are developing work disabilities. This
                                                    of information, and the public is                         Title of Collection: Prohibited                     request for information (RFI) seeks
                                                    generally not required to respond to an                 Transaction Class Exemption 1998–54                   public input on how the proposed
                                                    information collection, unless it is                    Relating to Certain Employee Benefit                  demonstration projects can best be
                                                    approved by the OMB under the PRA                       Plan Foreign Exchange Transactions                    designed to promote labor force
                                                    and displays a currently valid OMB                      Executed Pursuant to Standing                         attachment, coordinate employment and
                                                    Control Number. In addition,                            Instructions.                                         health services, and support injured and
                                                    notwithstanding any other provisions of                   OMB Control Number: 1210–0111.                      ill workers in returning to and
                                                    law, no person shall generally be subject                 Affected Public: Private Sector—                    remaining at work. The input we receive
                                                    to penalty for failing to comply with a                 businesses or other for-profits.                      will inform our deliberations about the
                                                                                                              Total Estimated Number of                           possible design of a future
                                                    collection of information that does not
                                                                                                            Respondents: 35.                                      demonstration project.
                                                    display a valid Control Number. See 5
                                                                                                              Total Estimated Number of
                                                    CFR 1320.5(a) and 1320.6. The DOL                                                                             DATES: Comments must be received by
                                                                                                            Responses: 420,000.
                                                    obtains OMB approval for this                                                                                 October 30, 2017.
                                                                                                              Total Estimated Annual Time Burden:
                                                    information collection under Control                                                                          ADDRESSES: You may submit comments
                                                                                                            4,200 hours.
                                                    Number 1210–0111.                                                                                             by any one of three methods—Internet,
                                                                                                              Total Estimated Annual Other Costs
                                                      OMB authorization for an ICR cannot                   Burden: $0.                                           fax, or mail. Do not submit the same
                                                    be for more than three (3) years without                                                                      comments multiple times or by more
                                                                                                              Authority: 44 U.S.C. 3507(a)(1)(D).
                                                    renewal, and the current approval for                                                                         than one method. Regardless of which
                                                    this collection is scheduled to expire on                 Dated: September 15, 2017.                          method you choose, please refer to
                                                    September 30, 2017. The DOL seeks to                    Michel Smyth,                                         Docket No. DOL–2017–0003in your
                                                    extend PRA authorization for this                       Departmental Clearance Officer.                       comment pages so that we may associate
                                                    information collection for three (3) more               [FR Doc. 2017–20916 Filed 9–28–17; 8:45 am]           your comments with the correct docket.
                                                    years, without any change to existing                   BILLING CODE 4510–29–P                                   Caution: In your comments, you
                                                    requirements. The DOL notes that                                                                              should be careful to include only the
                                                    existing information collection                                                                               information that you wish to make
                                                    requirements submitted to the OMB                       DEPARTMENT OF LABOR                                   publicly available. We strongly urge you
                                                    receive a month-to-month extension                                                                            not to include in your comments any
                                                                                                            [Agency Docket Number: DOL–2017–0003]
                                                    while they undergo review. For                                                                                personal information, such as Social
                                                    additional substantive information                      Request for Information on Potential                  Security numbers or medical
                                                    about this ICR, see the related notice                  Stay-at-Work/Return-to-Work                           information.
                                                    published in the Federal Register on                    Demonstration Projects                                   1. Internet: We strongly recommend
                                                    May 22, 2017 (82 FR 23303).                                                                                   that you submit your comments via the
                                                      Interested parties are encouraged to                  AGENCY:  Office of Disability
                                                                                                                                                                  Internet. Please visit the Federal
                                                    send comments to the OMB, Office of                     Employment Policy, DOL.
                                                                                                                                                                  eRulemaking portal at http://
                                                    Information and Regulatory Affairs at                   ACTION: Request for information.                      www.regulations.gov. Use the ‘‘Search’’
                                                    the address shown in the ADDRESSES                                                                            function to find docket number DOL–
                                                                                                            SUMMARY:   Washington State’s workers’
                                                    section within thirty (30) days of                                                                            2017–0003. The system will issue a
                                                                                                            compensation system runs several
                                                    publication of this notice in the Federal                                                                     tracking number to confirm your
                                                                                                            promising early intervention programs
                                                    Register. In order to help ensure                                                                             submission. You will not be able to
                                                                                                            including the Centers of Occupational
                                                    appropriate consideration, comments                                                                           view your comment immediately
                                                                                                            Health and Education (COHE) and the
                                                    should mention OMB Control Number                                                                             because we must post each comment
                                                                                                            Early Return to Work and the Stay at
                                                    1210–0111. The OMB is particularly                                                                            manually. It may take up to a week for
                                                                                                            Work programs, which provide early
                                                    interested in comments that:                                                                                  your comment to be viewable.
                                                                                                            intervention and return-to-work services
                                                      • Evaluate whether the proposed                       for individuals with work-related health                 2. Fax: Fax comments to (202) 693–
                                                    collection of information is necessary                  conditions and their employers. The                   7888.
                                                    for the proper performance of the                                                                                3. Mail: Mail your comments to the
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                                                                                                            President’s FY2018 budget proposed
                                                    functions of the agency, including                      that the Office of Disability Employment              Office of Disability Employment Policy,
                                                    whether the information will have                       Policy (ODEP) at the U.S. Department of               U.S. Department of Labor, 200
                                                    practical utility;                                      Labor (DOL) and the Social Security                   Constitution Avenue NW., S–1303,
                                                      • Evaluate the accuracy of the                        Administration (SSA) jointly conduct a                Washington, DC 20210.
                                                    agency’s estimate of the burden of the                  demonstration testing the effects of                     Comments are available for public
                                                    proposed collection of information,                     implementing key features of these                    viewing on the Federal eRulemaking
                                                    including the validity of the                           programs in other states and/or for a                 portal at http://www.regulations.gov or
                                                    methodology and assumptions used;                       broader population beyond workers’                    in person, during regular business


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                                                                                Federal Register / Vol. 82, No. 188 / Friday, September 29, 2017 / Notices                                                     45619

                                                    hours, by arranging with the contact                    (ERTW) and Stay at Work programs.5                     with an increased emphasis on access to
                                                    person identified below.                                Projects funded through the proposed                   employment-related supports. The
                                                    FOR FURTHER INFORMATION CONTACT:                        demonstration project, however, would                  ultimate policy goal is to increase
                                                    Jennifer Sheehy, Deputy Assistant                       include additional connections to                      employment and labor force
                                                    Secretary, Office of Disability                         existing employment services and                       participation of individuals with work
                                                    Employment Policy, U.S. Department of                   supports provided through the                          disabilities, and to identify and/or
                                                    Labor, 200 Constitution Avenue NW.,                     workforce development system.                          confirm effective strategies for doing so.
                                                    S–1303, Washington, DC 20210, (202)                       COHE, which is funded by                             For the purposes of this RFI, the term
                                                    693–7880, or visit https://www.dol.gov/                 Washington’s workers’ compensation                     ‘‘work disability’’ is defined as an
                                                    dol/contact/contact-                                    system, provides early intervention and                illness, injury, or medical condition that
                                                    phonecallcenter.htm (TTY), for                          RTW services for individuals with                      is anticipated to inhibit or prevent
                                                    information about this notice.                          work-related health conditions. An                     continued employment or labor force
                                                    SUPPLEMENTARY INFORMATION:
                                                                                                            evaluation of the COHE pilot in the                    participation.
                                                                                                            early 2000s produced promising results:
                                                    Purpose                                                 COHE participants were less likely to be                  This RFI offers interested parties the
                                                                                                            off work and on disability benefits one                opportunity to provide
                                                       Millions of American workers leave                                                                          recommendations on effective
                                                    the workforce each year after                           year after the claim, and combined
                                                                                                            medical and disability costs were                      approaches for the design and
                                                    experiencing an injury or illness.1                                                                            implementation of the demonstration
                                                    Hundreds of thousands of these workers                  reduced by $510 per claim for COHE
                                                                                                            participants. The magnitude of these                   project. We expect that public input
                                                    go on to receive state or Federal                                                                              provided in response to this request will
                                                    disability benefits.2 Many injured or ill               reductions was greater for back sprain
                                                                                                            cases (a common occupational injury):                  assist us in defining the scope and
                                                    workers could remain in their jobs or
                                                                                                            the relative risk of being off work and                design of the demonstration project. For
                                                    the workforce if they received timely,
                                                                                                            on disability at one year was 37 percent               example, a demonstration project could
                                                    effective supports.
                                                                                                            lower for back sprain COHE patients,                   test whether elements of the COHE
                                                       This request for information (RFI)
                                                    offers interested parties—including but                 and disability costs for back sprains                  workers’ compensation model, which
                                                    not limited to states, community-based                  were reduced by $542 per case.6                        focus on immediate or early
                                                    and other non-profit organizations,                     Preliminary analysis indicated that at                 intervention, could be combined with
                                                    philanthropic organizations,                            the eight-year mark, 26 percent fewer                  re-employment services provided
                                                    researchers, employers, health care                     COHE claimants received Social                         through the American Job Centers for
                                                    providers with assorted training and                    Security Disability Insurance (SSDI)                   the subset of participants who do not
                                                    specialties, private disability insurance               benefits.7                                             return to work within 90 days so that
                                                    providers, vocational rehabilitation                      The ERTW program and Stay at Work                    they could obtain additional
                                                                                                            programs in Washington State provide                   employment services and supports to
                                                    specialists, and members of the public—
                                                                                                            related assistance. The ERTW program                   maintain a workforce attachment. The
                                                    the opportunity to provide information
                                                                                                            helps injured and ill workers RTW as                   RFI specifically seeks public input on
                                                    and recommendations to inform the
                                                                                                            soon as medically possible by providing                how the proposed demonstration
                                                    development of a potential grant
                                                                                                            access to a team of vocational services                projects can best be designed to promote
                                                    program aimed at reducing long-term
                                                                                                            consultants, therapists, and nurse                     labor force attachment, coordinate
                                                    disability and increasing labor force
                                                                                                            consultants to assist with developing                  employment and health services, and
                                                    participation among workers who are
                                                                                                            and implementing medically                             support injured and ill workers in
                                                    injured or become ill while employed.
                                                                                                            appropriate RTW options. The Stay at                   returning to and remaining at work.
                                                    Background                                              Work program is a financial incentive                     Background on the COHE model and
                                                       The President’s 2018 budget supports                 program that reimburses employers for                  Early Return to Work and Stay at Work
                                                    a demonstration to test promising Stay-                 some of their costs when providing                     programs:
                                                    at-Work/Return-to-Work (SAW/RTW)                        temporary, light-duty jobs for injured
                                                                                                            workers while they heal.                                  As the proposed demonstration is
                                                    strategies aimed at improving labor
                                                                                                              This demonstration will draw from                    based on elements from Washington
                                                    force participation, employment, and
                                                                                                            and test key features of the Washington                State’s COHE, ERTW, and Stay at Work
                                                    earnings outcomes for workers who are
                                                                                                            COHE model and ERTW and Stay at                        programs, the following background
                                                    injured or become ill.
                                                                                                            Work programs, in other states and/or                  material is provided about these
                                                       The proposed demonstration program
                                                                                                            for a population beyond workers’                       programs. There are six COHE centers
                                                    is modeled after promising programs in
                                                                                                            compensation (i.e., for non-occupational               across the state of Washington,
                                                    Washington State including the Centers
                                                                                                            injuries and illnesses). To do that, we                including some housed in large medical
                                                    for Occupational Health and Education
                                                                                                            anticipate funding states to operate one               systems and others that are community-
                                                    (COHE) 3 and the Early Return to Work 4
                                                                                                            or more COHE-style programs, or fund                   based. Each of these centers 8 recruits
                                                      1 Bardos, Maura, Hannah Burak, and Yonatan            the expansion of existing programs,                    and trains health care providers in their
                                                    Ben-Shalom. ‘‘Assessing the Costs and Benefits of                                                              area—often orthopedists or other
                                                    Return-to-Work Programs.’’ Final report submitted         5 http://lni.wa.gov/Main/StayAtWork/.                doctors specializing in treating workers’
                                                    to the U.S. Department of Labor, Office of Disability     6 Wickizer, T.M., Franklin, G., Fulton-Kehoe, D.,    compensation (WC) patients. COHE
                                                    Employment Policy. Washington, DC: Mathematica
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                                                                                                            Gluck, J., Mootz, R., Smith-Weller, T., and Plaeger-   started as a small pilot in two regions
                                                    Policy Research, March 2015.                            Brockway, R. (2011) ‘‘Improving Quality,
                                                      2 Social Security Administration, ‘‘Annual
                                                                                                            Preventing Disability and Reducing Costs in
                                                                                                                                                                   and has grown to currently include
                                                    Statistical Report on the Social Security Disability    Workers’ Compensation Healthcare: A Population-        about 3,500 health care providers who
                                                    Insurance Program, 2015.’’ SSA Publication No. 13–      based Intervention Study.’’ Medical Care, Vol. 49,     cover about 60 percent of all WC claims
                                                    11826. Washington, DC: Social Security                  No. 12, pp. 1105–1111.                                 in the state. Injured workers retain
                                                    Administration, October 2016.                             7 Franklin, G.M., Wickizer, T.M., Coe, N.B, and
                                                      3 http://www.lni.wa.gov/ClaimsIns/Providers/                                                                 health care provider choice. They
                                                                                                            Fulton-Kehoe, D. (2015) ‘‘Workers’ Compensation:
                                                    ProjResearchComm/OHS/default.asp.                       Poor Quality Health Care and the Growing
                                                      4 http://www.lni.wa.gov/ClaimsIns/Insurance/          Disability Problem in the United States.’’ American       8 Grantees will not be required to establish a

                                                    Injury/LightDuty/Ertw/Default.asp.                      Journal of Industrial Medicine, 58: 245–251.           ‘‘center’’ or new entity as part of the demonstration.



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                                                    45620                       Federal Register / Vol. 82, No. 188 / Friday, September 29, 2017 / Notices

                                                    receive COHE services if they choose a                  on those at risk for long-term disability,            percent of the base wages they pay the
                                                    COHE-affiliated provider for their care.                typically less than a quarter of all cases.           injured worker and some of the cost of
                                                       Given that health care providers often               The health service coordinator role is                training, tools, or clothing the worker
                                                    see relatively few patients who are at                  critical and depends heavily on the                   needs to do the light-duty or transitional
                                                    risk of labor force separation due to                   neutrality of health service coordinators             work.
                                                    their illness or injury, many may have                  in helping the health care and RTW                       The COHE model focuses services on
                                                    limited knowledge and resources to                      system work effectively for patients,                 the first 12 weeks after injury because
                                                    address the employment-related needs                    employers, health care providers, and                 this period is most critical in
                                                    of this population. Health care providers               the insurer. This neutrality allows                   maximizing the likelihood of RTW.
                                                    affiliated with COHE, however, receive                  health service coordinators to be trusted             While the proposed demonstration
                                                    training in occupational health best                    by the various stakeholders, allowing                 builds upon the COHE model and the
                                                    practices for these cases, including the                health service coordinators to maximize               ERTW and Stay at Work programs, it
                                                    following four best practices:                          the likelihood of the best-case recovery              differs from the original model by
                                                       1. Submitting a complete Report of                   and employment outcome.                               adding an extended focus on
                                                    Accident (ROA) in two business days or                     As a program based in the medical                  employment services and supports and
                                                    less;                                                   system, COHE depends heavily on                       a strong and purposeful involvement of
                                                       2. Developing an activity plan, which                project champions among sponsoring                    the workforce development system.
                                                    communicates the worker’s ability to                    health care organizations’ leadership to
                                                    participate in work activities, activity                                                                      Potential Project Scope
                                                                                                            create organizational buy-in and
                                                    restrictions, and the provider’s                        support. Additionally, each COHE                         DOL and SSA anticipate three
                                                    treatment plans;                                        participates in a Regional Business-                  acquisitions for this project:
                                                       3. Communicating directly with                       Labor Advisory Board that ensures                     Implementation grants awarded via a
                                                    employers when injured workers are                      community support and solicits input                  cooperative agreement, a technical
                                                    absent or expected to be absent from                    from local business and labor interests.              assistance contract to support grantees,
                                                    work; and                                                  Key features of the COHE model of                  and an evaluation contract. The
                                                       4. Assessing the injured worker’s                    interest to the proposed demonstration                agencies anticipate implementing the
                                                    barriers to return to work and                          include:                                              demonstration in two to three states
                                                    developing a plan to overcome them.                        1. Coordination of services, including             representing diverse programmatic
                                                       Health service coordinators are                      enhanced stakeholder communication,                   contexts and with the ability to provide
                                                    integral to the success of the COHE                     RTW planning, and identification of                   meaningful analyses and policy
                                                    model. The program is based on the                      potential delays and solutions to keep                recommendations. There would be a
                                                    MacColl chronic care model.9                            treatment and RTW plans on track;                     separate technical assistance (TA)
                                                    Successful health service coordinators                     2. Physician training on occupational              contract to assist states with
                                                    are skilled in vocational rehabilitation                health best practices;                                implementation and a separate
                                                    and motivational interviewing and work                     3. Incentives for physicians to utilize            integrated evaluation contract to
                                                    directly with injured workers,                          the best practices for participating                  evaluate all of the sites and address
                                                    employers, health care providers, and                   patients;                                             specific research goals. For the purposes
                                                    other stakeholders to coordinate care                      4. A data management system                        of this RFI, the implementation grantees
                                                    and RTW activities for injured workers.                 allowing services coordinators real-time              are referred to as the ‘‘projects,’’ the
                                                    They also help stakeholders navigate the                access to all relevant information on                 technical assistance contractor is
                                                    workers’ compensation system by                         each case to support effective triage,                referred to as the ‘‘TA provider,’’ and
                                                    performing claim coordination                           population monitoring, and case                       the evaluation contractor is referred to
                                                    functions, such as ensuring forms are                   management.                                           as the ‘‘evaluator.’’
                                                    received and complete and contacting                       The ERTW program helps injured and                    We anticipate designing this
                                                    stakeholders as needed for clarifications               ill workers RTW as soon as medically                  demonstration to solicit innovative
                                                    or follow-up. Health service                            possible by providing access to a team                projects that create systems changes by
                                                    coordinators frequently contact injured                 of specialists including vocational                   targeting individuals when they are in
                                                    workers, employers, health care                         services consultants, therapist                       the early stages of developing a work
                                                    providers, state agency staff, and other                consultants, and nurse consultants who                disability, and assisting them in
                                                    stakeholders to help with the RTW                       assist health care providers and                      maintaining a connection to the labor
                                                    process, and identify barriers to                       employers develop and implement                       force, preferably through their current or
                                                    returning to work and resources to                      medically appropriate RTW options.                    most recent employer. Projects will be
                                                    resolve them. The RTW activities they                   Resources available to employers                      encouraged to build upon existing
                                                    coordinate for the patient can include                  include risk management specialists,                  programs or systems, such as state-based
                                                    functional assessments, referrals to                    safety consultants to provide on-site                 temporary disability insurance (TDI)
                                                    existing training and employment                        consultations, and job modification                   programs, collaborative health care
                                                    services, and setting appropriate RTW                   funds. By providing these resources, the              organizations, disability management
                                                    expectations. Health service                            ERTW program speeds the worker’s                      insurance providers, or workers’
                                                    coordinators also educate employers on                  recovery and reduces the financial                    compensation programs. We would also
                                                    the financial and other benefits of                     impact of a workers’ compensation                     encourage projects to think broadly
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                                                    retaining injured workers and can refer                 claim on the worker, the employer, and                about new and effective ways to prevent
                                                    employers to the ERTW and Stay at                       the workers’ compensation system.                     the development of long-term work
                                                    Work programs for resources and                            The Stay at Work program                           disability. The solicitation will leave
                                                    financial incentives to help them with                  incentivizes employers to offer                       flexibility for applicants to develop their
                                                    job accommodation. The health service                   temporary light-duty work to injured                  own projects that adapt to the specific
                                                    coordinators monitor all cases, but focus               employees while they heal, by                         programmatic, demographic, and
                                                                                                            reimbursing the employers for some of                 economic contexts of their state or
                                                      9 See http://www.improvingchroniccare.org/            the costs of providing such jobs. Eligible            region while also satisfying the project’s
                                                    index.php?p=The_Chronic_Care_Model&s=2.                 employers can be reimbursed for 50                    requirements.


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                                                                                Federal Register / Vol. 82, No. 188 / Friday, September 29, 2017 / Notices                                            45621

                                                       Preliminary required design elements                 representatives) up front and on an                   served, the extent to which those served
                                                    of the demonstration are described                      ongoing basis; and                                    experience improved outcomes
                                                    below. We encourage public input and                       • A data management system that:                   (including labor market outcomes,
                                                    comment on these elements in response                      Æ (1) allows service coordinators real-            receipt of SSDI/SSI), and a cost-benefit
                                                    to the questions in the following                       time access to all relevant information               analysis. The impact study would
                                                    section.                                                on each case for purposes of triage,                  include a process evaluation and
                                                       Overview: We anticipate funding                      individual case management, and                       participation analysis in order to assess
                                                    implementation grants in two to three                   population health monitoring, including               the implementation and fidelity of the
                                                    states to either operate one or more                    on disability time loss duration; and                 program and general interest and take-
                                                    projects with key elements drawn from                      Æ (2) supports the evaluation of the               up rates across the project sites. The
                                                    the COHE model and the ERTW and                         project.                                              evaluation design would be finalized
                                                    Stay at Work programs, with an added                       Eligible grant applicants: We                      once the evaluator is secured and would
                                                    emphasis on access to employment-                       anticipate requiring each project and                 take into account the specifics of the
                                                    related services and supports, or the                   application to have a state agency                    funded projects. All projects would be
                                                    expansion of similar existing programs                  designated as the lead coordinating                   required to fully cooperate with and
                                                    to include increased access to                          entity. The lead agency would be                      participate in the evaluation.
                                                    employment-related supports and                         required or encouraged to form                           Data collection: Projects would be
                                                    services. The ultimate policy goal is to                partnerships with other public or                     required to provide for centralized data
                                                    increase employment and labor force                     private organizations, such as DOL-                   collection to capture care management,
                                                    participation of individuals with work                  funded employment-service providers,                  RTW coordination information, and
                                                    disabilities through timely and effective               state vocational rehabilitation agencies,             measures and outcomes of interest to
                                                    coordination of health care and                         private non-profit organizations, health              the evaluation. The evaluation
                                                    employment-related services. Each                       care providers/organizations, other                   contractor would be provided access to
                                                    grantee would be responsible for                        public or private organizations, state                this data. A data management system
                                                    identifying, recruiting, and training                   and local Workforce Investment Boards,                would be required to allow the service
                                                    health care providers within their                      and county or municipal-level
                                                                                                                                                                  coordinators and others in the
                                                    geographic area, and incentivizing their                governments as appropriate.
                                                                                                                                                                  intervention to have real-time access to
                                                    use of occupational health best practices                  Population: Each project would be
                                                                                                            required to identify and clearly define               all relevant information on each case in
                                                    for eligible workers. In addition, each                                                                       order to effectively triage, monitor, and
                                                    grantee would be responsible for                        its target population, including showing
                                                                                                            that the population has a substantial                 intervene as needed on a timely basis.
                                                    providing and supporting return to work                                                                       Projects would be encouraged to use or
                                                    service coordinators who will                           risk of developing a long-term work
                                                                                                            disability, and/or transitioning to Social            adapt existing centralized data systems.
                                                    coordinate and facilitate the RTW                                                                                Evaluation: We anticipate evaluating
                                                    process for eligible workers. Grantees                  Security Disability Insurance (SSDI) or
                                                                                                                                                                  projects on two primary research
                                                    would also be responsible for providing                 Supplemental Security Income (SSI),
                                                                                                                                                                  questions:
                                                    a centralized data collection and                       such that the intervention could change                  • Does the intervention improve
                                                    reporting system for the efficient                      their employment outcomes. Projects                   employment outcomes compared to the
                                                    management of the care and RTW                          are encouraged to include workers with                control group?
                                                    coordination system, and to support the                 active state TDI or workers’                             • Does the intervention reduce
                                                    evaluation of the program.                              compensation claims, or those using                   application to Social Security Disability
                                                       We anticipate requiring funded                       paid leave, as well as broader                        Insurance (SSDI) or Supplemental
                                                    projects to include the following                       populations of workers experiencing the               Security Income (SSI)?
                                                    treatment elements:                                     onset of a medical condition that could                  Below are additional research
                                                       • Coordination of services, including                result in a work disability. The target               questions of interest, which may not all
                                                    enhanced stakeholder communication,                     population must be clearly identifiable               be answered by the initial evaluation of
                                                    RTW planning, and identification of                     using existing administrative records,                the proposed demonstration:
                                                    potential delays and solutions to keep                  easily completed screening forms, or an                  • Does the intervention increase labor
                                                    treatment and RTW plans on track;                       information management system, and                    force participation of participating
                                                       • Health care provider training on                   there must be a clear mechanism that                  workers?
                                                    occupational health best practices that                 triggers the start of services.                          • Does the intervention increase labor
                                                    COHE uses;                                                 Participant Recruitment: Each grantee              force attachment of participating
                                                       • Incentives for health care providers               would propose a recruitment plan for                  workers?
                                                    to utilize the specified best practices for             outreach and enrollment of worker                        • Does the intervention reduce labor
                                                    participating patients;                                 participants based on their target                    force exit of participating workers?
                                                       • Possible incentives for employers to               population and their project design.                     • Does the intervention maintain or
                                                    actively participate in worker retention                Grantees would be required to be able                 result in increased wages of
                                                    and other RTW efforts through                           to recruit a sufficient number of worker              participating workers?
                                                    utilization of strategies such as                       participants to allow for a meaningful                   • Does the intervention improve the
                                                    temporary light-duty jobs, job                          assessment of the impact of the                       ability of participating workers to
                                                    modifications, and job-banking;                         intervention. Applicants would also be                maintain hours of work?
                                                       • Provision of, or facilitated access to,                                                                     • Does the intervention reduce
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                                                                                                            required to recruit and have signed
                                                    employment-related services and                         MOUs or letters of intent with project                medical, time lost, or litigation costs?
                                                    supports (such as needs assessments,                    partners, including partnering health                    • What are optimal and efficient
                                                    skill assessments, accommodations, job                  care providers.                                       methods to identify target populations
                                                    coaching, job search assistance if not                     Evaluation Design: We anticipate                   at risk of exiting the labor force that will
                                                    remaining with original employer) and                   carrying out an impact and                            benefits from the intervention?
                                                    training;                                               implementation study to understand                       • What is the best timing to engage a
                                                       • Engaging key stakeholders (e.g., the               how the programs are implemented,                     worker effectively while also
                                                    business community, labor                               service components, who is being                      minimizing cost?


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                                                    45622                       Federal Register / Vol. 82, No. 188 / Friday, September 29, 2017 / Notices

                                                       • What recruitment methods are most                  Questions                                             be provided during the same time
                                                    effective to engage a target population?                                                                      window as the health care services/
                                                       • Does the intervention decrease SSDI                I. Intervention Elements
                                                                                                                                                                  coordination, or afterwards? How can
                                                    or SSI allowance rates?                                    1. Are there potential issues with the             the RTW service coordinators best
                                                       • What elements of the intervention                  treatment elements listed under                       facilitate the effective use of
                                                    are most influential in determining                     ‘‘required treatment elements’’ on pages              employment services?
                                                    success (i.e., improved employment                      6–7? Should any not be required? What                    8. What role should employer
                                                    outcomes and reduced need for SSDI or                   other elements might be useful, and                   incentives play in this intervention? Are
                                                    SSI benefits)?                                          what is the evidence base for them?                   there particular employer incentives
                                                       • What environmental factors are                     What additional optional services and                 that we should consider in projects
                                                    necessary for successful implementation                 supports could grantees choose to                     where workers’ compensation insurance
                                                    of the intervention?                                    include in the model? What is the                     premiums play a limited role? Are there
                                                       • What are the cost effective and                    existing evidence documenting the                     effective non-financial ways to engage
                                                    efficient interventions that reduce                     effectiveness of these additional                     and incentivize employers to support
                                                    workers exit from the labor force?                      optional services and supports?                       and implement SAW/RTW programs
                                                       • What are the effective and efficient                  2. What should be the required and                 within their workplaces?
                                                    strategies to incentivize employers to                  optional roles and responsibilities of the               9. What is an appropriate health care
                                                    actively retain workers with injuries and               RTW service coordinator in                            provider payment or fee structure to
                                                    health conditions?                                      implementing the treatment elements?                  incentivize the specific occupational
                                                       • What are effective and efficient                      3. Where should the role of a RTW                  health best practices and to encourage a
                                                    strategies to create buy-in from health                 service coordinator be housed in order                focus on employment as a health
                                                    care providers that work is an important                to most effectively accomplish its goals,             outcome? Are there models other than
                                                    health care outcome?                                    including an ability to maintain                      fee-for-service that would be
                                                    Request for Information                                 neutrality? For example, should service               appropriate and feasible, such as basing
                                                                                                            coordinators be employed by health care               payments on process and/or outcome
                                                       This request for information (RFI)                   provider networks, by the public
                                                    seeks public input on how the proposed                                                                        metrics? How would these models
                                                                                                            workforce system, by private disability               operate in the context of managed-care
                                                    demonstration projects can best be                      insurance providers, by employers, or
                                                    designed to promote labor force                                                                               organizations?
                                                                                                            by another entity?                                       10. How can health systems and
                                                    attachment, coordinate employment and                      4. Should there be educational and/or              health care providers be better
                                                    health services, and support injured and                experience requirements for the RTW                   incentivized to consider employment a
                                                    ill workers in returning to and                         service coordinators, such as vocational              valid health outcome? What is the
                                                    remaining at work. Through this notice,                 counseling or public health                           recent relevant evidence documenting
                                                    we are soliciting feedback from                         backgrounds? How should these                         the effectiveness of incentive models
                                                    interested parties on the scope and                     educational and experience                            (including financial or other incentives)
                                                    design of a potential demonstration                     requirements parallel and differ from                 that include employment as an
                                                    project related to providing coordinated                those of health navigators, community                 outcome?
                                                    occupational health and employment                      health workers, and vocational
                                                    services to individuals who become                      rehabilitation counselors?                            II. Target Population and Sites
                                                    injured or ill while employed in order                     5. What specific employment-related                   11. What is an appropriate age range
                                                    to enable them to remain in the labor                   interventions should be required or                   of participants to target for this
                                                    force, thereby improving their                          allowed? What evidence supports these                 demonstration project? For example,
                                                    employment and earnings outcomes and                    interventions as effective in early                   should the demonstration projects target
                                                    maximizing their self-sufficiency.                      intervention for these populations?                   prime-age workers (25–54)? Why or why
                                                    Responses to this request will inform                   When referrals to existing employment-                not?
                                                    decisions about the development,                        related service providers occur, will                    12. What populations of RTW
                                                    design, and evaluation of the potential                 these providers have sufficient capacity              participants—such as those listed
                                                    demonstration project.                                  and funding to provide services in a                  below—should be allowed, encouraged,
                                                       This notice is for internal planning                 timely manner to referred individuals?                or required in the demonstration? Why
                                                    purposes only and should not be                            6. The COHE model focuses                          should the populations you recommend
                                                    construed as a solicitation or as an                    interventions primarily in the first 12               be included? Are there populations of
                                                    obligation on the part of the Department                weeks after injury/illness (with                      RTW participants that you would not
                                                    of Labor or any participating Federal                   occasional exceptions allowing up to 26               recommend?
                                                    agencies. We ask respondents to address                 weeks). For a demonstration such as this                 D Individuals with active state-based
                                                    the following questions, where possible,                requiring increased involvement of the                TDI claims?
                                                    in the context of the discussion in this                workforce development system, what is                    D Workers accessing FMLA benefits
                                                    document. You do not need to address                    the optimal timing and length of                      (except for pregnancy and caring for
                                                    every question and should focus on                      intervention? Why, or what is the                     others)?
                                                    those that relate to your expertise or                  evidence base?                                           D Individuals with active WC claims?
                                                    perspectives. To the extent possible,                      7. Employment services (such as                       D Others (not participating in WC or
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                                                    please clearly indicate which                           needs assessments, skill assessments,                 TDI) experiencing the onset of a medical
                                                    question(s) you address in your                         accommodations, job coaching, job                     condition that could affect their
                                                    response. We ask that each respondent                   search assistance if not remaining with               connection to the workforce?
                                                    include the name and address of his or                  original employer) and the public                        13. How should the target population
                                                    her institution or affiliation, if any, and             workforce system are important                        described above be specifically defined
                                                    the name, title, mailing and email                      elements of the proposed demonstration                and cleanly identified? We are
                                                    addresses, and telephone number of a                    program. What is the optimal time to                  particularly interested in how to define
                                                    contact person for his or her institution               provide employment services? For                      an appropriate population that is not
                                                    or affiliation, if any.                                 example, should employment services                   limited to individuals with state-based


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                                                                                Federal Register / Vol. 82, No. 188 / Friday, September 29, 2017 / Notices                                                45623

                                                    TDI claims or WC. What are the most                     If so, what functions should be                       a potential comparison group be
                                                    appropriate eligibility criteria (such as               required?                                             identified? If other randomized designs
                                                    time off work, type of condition, type of                  21. Should groups of states be allowed             are recommended, what are potential
                                                    employment) to identify such                            to jointly apply? Why or why not?                     units for random assignment and points
                                                    individuals? What kinds of ‘‘triggers’’                    22. Could a non-state (i.e., county or             at which assignment would occur?
                                                    would work for the population as a                      local government) or non-governmental
                                                                                                            (i.e., non-profit or private organization)            Rights to Materials Submitted
                                                    mechanism for enrollment into the
                                                    project?                                                entity serve as the primary applicant                    By submitting material in response to
                                                       14. Are there specific functional risk               and fiscal agent? If so, what                         this notice, you agree to grant us a
                                                    assessment instruments that you                         characteristics should be required of                 worldwide, royalty-free, perpetual,
                                                    recommend using for this project? What                  such entities? Would this be preferable               irrevocable, nonexclusive license to use
                                                    are the benefits and limitations of those               to a state governmental agency serving                the material, and to post it publicly.
                                                    instruments? How might they be used to                  in this role? Why or why not?                         Further, you agree that you own, have
                                                    identify the target population here or                     23. The COHE model in Washington                   a valid license, or are otherwise
                                                    form the basis for an RTW plan?                         operates within a monopolistic WC                     authorized to provide the material to us.
                                                       15. Are there aspects of your state’s                system, which allows for centralized                  You should not provide any material
                                                    TDI, paid leave, FMLA, WC, or other                     participant controls, service                         you consider confidential or proprietary
                                                    state programs that would pose                          management, and data collection.                      in response to this notice. We will not
                                                    particular advantages or challenges for                 Would states with other WC models,                    provide any compensation for material
                                                    identifying workers who might benefit                   such as privately managed and                         submitted in response to this notice.
                                                    from an intervention like the one                       competitive WC markets, be able to
                                                                                                                                                                  Jennifer Sheehy,
                                                    discussed above? Are there aspects of                   feasibly implement a similar model,
                                                    these programs that would pose                          particularly with regard to data                      Deputy Assistant Secretary for Disability
                                                                                                                                                                  Employment Policy.
                                                    particular advantages or challenges for                 collection? If so, how? Would states
                                                                                                                                                                  [FR Doc. 2017–20338 Filed 9–28–17; 8:45 am]
                                                    collecting data on treatments, services,                with short-term or temporary disability
                                                                                                                                                                  BILLING CODE P
                                                    and outcomes for a project like this?                   insurance programs or states with
                                                       16. Should the target population be                  mandatory paid sick leave be able to do
                                                    limited to individuals with certain types               so, and how? In other words, should
                                                    of medical conditions, such as                          grant applicants be limited to states                 LEGAL SERVICES CORPORATION
                                                    musculoskeletal conditions and chronic                  with specific characteristics, and why or
                                                    health conditions? Why or why not?                                                                            Notice to LSC Grantees of Application
                                                                                                            why not?
                                                       17. How should project service areas                    24. What partners, public or private,              Process for Subgranting 2017–2018
                                                    be defined? For example, should                         should be required or encouraged as                   Pro Bono Innovation Fund and
                                                    demonstrations be carried out state-                    part of the demonstration project? What               Technology Initiative Grant Funds
                                                    wide, in specific counties, regions, or                 other entities might be beneficial as                 AGENCY:  Legal Services Corporation.
                                                    local communities? Would these service                  collaborators? In what ways could they                ACTION: Notice of application dates and
                                                    areas have a large enough target                        assist?                                               format for LSC Technology Initiative
                                                    population for evaluation purposes?                                                                           Grants and Pro Bono Innovation Fund
                                                       18. What types of entities would be                  IV. Evaluation and Design Issues
                                                                                                                                                                  subgrant applications.
                                                    the most beneficial to consider                           25. Are there research questions, not
                                                    partnering with to provide the COHE-                    specified above, that could be answered               SUMMARY:   The Legal Services
                                                    style services, and why? Examples                       through the evaluation which would                    Corporation (LSC) announces the
                                                    could include large health-care systems,                improve understanding of ways to better               submission dates for applications for
                                                    collections of small health care provider               serve and increase employment and                     subgrants under its Technology
                                                    offices, private self-insured employers                 labor force participation of individuals              Initiative Grants and its Pro Bono
                                                    with in-house disability management,                    with work disabilities?                               Innovation Fund grants starting after
                                                    vocational rehabilitation providers,                      26. What entity would be most                       October 30, 2017. LSC is also providing
                                                    accountable or managed care                             successful in recruiting participants                 information about the location of
                                                    organizations, federally qualified                      who have a qualifying injury or health                subgrant application forms and
                                                    community health centers, community                     condition (that makes them at risk for                directions.
                                                    based organizations, and urgent care                    leaving the labor force)? Examples could
                                                                                                                                                                  DATES: See SUPPLEMENTARY INFORMATION
                                                    centers.                                                include an insurance company, state
                                                                                                                                                                  section for application dates.
                                                                                                            TDI or WC insurance providers, an
                                                    III. Eligible Applicants                                employer, or a health care provider.                  ADDRESSES: Legal Services
                                                       19. What types of state government                     27. Do health systems and/or health                 Corporation—Office of Compliance and
                                                    entities are the most logical or well-                  care providers utilize risk predictors to             Enforcement, 3333 K Street NW., Third
                                                    positioned to serve as the primary                      target specific types of services? If so,             Floor, Washington, DC 20007–3522.
                                                    applicant and fiscal agent? What is the                 which predictors are used, and for                    FOR FURTHER INFORMATION CONTACT:
                                                    best way to organize the structure of a                 which services? Are any employment-                   Office of Compliance and Enforcement
                                                    demonstration like the one described                    or SAW/RTW-related?                                   by email at subgrants@lsc.gov, or visit
                                                                                                                                                                  the LSC Web site at http://www.lsc.gov/
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                                                    above in your state? What structure                       28. If a cluster-randomized design is
                                                    would best enable effective leadership,                 used for an experimental impact                       grants-grantee-resources/grantee-
                                                    responsibility, and accountability for                  evaluation, how could the unit of                     guidance/how-apply-subgrant.
                                                    the project? Would a single agency be                   randomization be defined and                          SUPPLEMENTARY INFORMATION: LSC
                                                    the natural lead for the project?                       operationalized within various types of               revised its subgrant rule, 45 CFR part
                                                       20. Similar state functions may be                   grantee sites? Are there other evaluation             1627, effective April 1, 2017. The
                                                    housed in different agencies, depending                 designs (randomized or not) that would                revised rule requires LSC to publish, on
                                                    on the state. Should key functions be                   be more feasible (e.g. quasi-                         an annual basis, ‘‘notice of the
                                                    required, rather than specific agencies?                experimental design)? If so, how could                requirements concerning the format and


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Document Created: 2017-09-29 03:27:25
Document Modified: 2017-09-29 03:27:25
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionRequest for information.
DatesComments must be received by October 30, 2017.
ContactJennifer Sheehy, Deputy Assistant Secretary, Office of Disability Employment Policy, U.S. Department of Labor, 200 Constitution Avenue NW., S-1303, Washington, DC 20210, (202) 693-7880, or visit https://www.dol.gov/dol/contact/contact- phonecallcenter.htm (TTY), for information about this notice.
FR Citation82 FR 45618 

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