[Federal Register Volume 84, Number 217 (Friday, November 8, 2019)]
[Notices]
[Pages 60457-60458]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-24359]
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DEPARTMENT OF LABOR
Office of Workers' Compensation Programs
Proposed Extension of Existing Collections; Comment Request
ACTION: Notice.
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SUMMARY: The Department of Labor, as part of its continuing effort to
reduce paperwork and respondent burden, conducts a preclearance
consultation program to provide the general public and Federal agencies
with an opportunity to comment on proposed and/or continuing
collections of information in accordance with the Paperwork Reduction
Act of 1995 (PRA95). This program helps to ensure that requested data
can be provided in the desired format, reporting burden (time and
financial resources) is minimized, collection instruments are clearly
understood, and the impact of collection requirements on respondents
can be properly assessed. Currently, the Office of Workers'
Compensation Programs is soliciting comments concerning the proposed
collection: Claim for Compensation by Dependents Information Reports
(CA-5, CA-5b, CA-1031, CA-1074, Letter of Compensation Due at Death,
and Letter of Student/Dependency). A copy of the proposed information
collection request can be obtained by contacting the office listed
below in the addresses section of this Notice.
DATES: Written comments must be submitted to the office listed in the
addresses section below on or before January 7, 2020.
ADDRESSES: You may submit comments by mail, delivery service, or by
hand to Anjanette Suggs, U.S. Department of Labor, 200 Constitution
Ave. NW, Room S-3323, Washington, DC 20210; by fax, (202) 354-9660, or
email to [email protected]. Please use only one method of
transmission for comments (mail or email).
SUPPLEMENTARY INFORMATION: I. Background: The forms included in this
package are forms used by Federal employees and their dependents to
claim benefits, to prove continued eligibility for benefits, to show
entitlement to remaining compensation payments of a deceased employee
and to show dependency under the Federal Employees' Compensation Act.
There are six items in this information collection request. The
information collected by Forms CA-5, is used by dependents for claiming
compensation for the work related death of a Federal Employee and CA-5b
is used by other survivors. Form CA-1031 is used in disability cases
and provides information to determine whether a claimant is actually
supporting a dependent and is entitled to additional compensation. Form
CA-1074 is a follow up to CA-5b to request clarification of any
information that is unclear and incomplete in the CA-5b. The letter of
``Compensation Due at Death'' is used to request information necessary
to distribute compensation due when an employee dies who was receiving
or who was entitled to compensation at the time of death for either
disability benefits or a scheduled award. The letter of ``Student/
Dependency'' is used to obtain information regarding the student status
of a dependent. When a child reaches 18 years of age, they are no
longer considered an eligible dependent unless they are a full time
student or incapable of self-support. This information collection is
currently approved for use through August 31, 2016.
II. Review Focus: The Department of Labor is particularly
interested in comments which:
* Evaluate whether the proposed collection of information is
necessary for the proper performance of the functions of the agency,
including whether the information will have practical utility;
* evaluate the accuracy of the agency's estimate of the burden of
the proposed collection of information, including the validity of the
methodology and assumptions used;
* enhance the quality, utility and clarity of the information to be
collected; and
* minimize the burden of the collection of information on those who
are to respond, including through the use of appropriate automated,
electronic, mechanical, or other technological collection techniques or
other forms of information technology, e.g., permitting electronic
submissions of responses.
III. Current Actions: The Department of Labor seeks extension of
approval to collect this information in order to carry out its
responsibility to meet the statutory requirements of the Federal
Employees' Compensation Act. The information contained in these forms
is used by the Division of Federal Employees' Compensation to determine
entitlement to benefits under the Act, to verify dependent status, and
to initiate, continue, adjust, or terminate benefits based on
eligibility criteria.
Type of Review: Extension.
Agency: Office of Workers' Compensation Programs.
Title: Claim for Compensation by Dependents Information Reports.
OMB Number: 1240-0013.
Agency Number: CA-5, CA-5b, CA-1031, CA-1074, Letter of
Compensation Due at Death, and Letter of Student/Dependency.
Affected Public: Individuals or households.
Total Respondents: 933.
Total Responses: 933.
[[Page 60458]]
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Time to
Form/letter complete Frequency of Number of Hours burden
(minutes) response respondents
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CA-5/5b......................................... 90 1 333 500
CA-1031......................................... 20 1 38 13
CA-1074......................................... 60 1 10 10
Student Dependency.............................. 30 1 299 150
Comp Due at Death............................... 30 1 253 127
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Totals...................................... .............. .............. 933 800
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Estimated Total Burden Hours: 800.
Total Burden Cost (capital/startup): $0.
Total Burden Cost (operating/maintenance): $541.
Comments submitted in response to this notice will be summarized
and/or included in the request for Office of Management and Budget
approval of the information collection request; they will also become a
matter of public record.
Ajanette Suggs,
Agency Clearance Officer, Office of Workers' Compensation Programs,
U.S. Department of Labor.
[FR Doc. 2019-24359 Filed 11-7-19; 8:45 am]
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