[Federal Register Volume 78, Number 48 (Tuesday, March 12, 2013)]
[Notices]
[Pages 15742-15743]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-05590]
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DEPARTMENT OF LABOR
Office of Workers' Compensation Programs
Division of Federal Employees' Compensation Proposed Extension of
Existing Collection; 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) [44 U.S.C. 3506(c)(2)(A)]. This program helps to
ensure that requested data can be provided in the desired format,
reporting burden (time and financial resources) is minimized,
collection instruments are clearly understood, and the impact of
collection requirements on respondents can be properly assessed.
Currently, the Office of Workers' Compensation Programs is soliciting
comments concerning the proposed collection: Claim for Compensation by
Dependents Information Reports (CA-5, CA-5b, CA-1031, CA-1074, Letter
of Compensation Due at Death and Letter of Student/Dependency). A copy
of the proposed information collection request can be obtained by
contacting the office listed below in the addresses section of this
Notice.
DATES: Written comments must be submitted to the office listed in the
addresses section below on or before May 13, 2013.
ADDRESSES: Ms. Yoon Ferguson, U.S. Department of Labor, 200
Constitution Ave. NW., Room S-3233, Washington, DC 20210, telephone
(202) 693-0701, fax (202) 693-1447, Email [email protected]. Please
use only one method of transmission for comments (mail, fax, or Email).
SUPPLEMENTARY INFORMATION:
I. Background
The forms included in this package are forms used by Federal
employees and their dependents to claim benefits, to prove continued
eligibility for benefits, to show entitlement to remaining compensation
payments of a deceased employee and to show dependency under the
Federal Employees' Compensation Act. There are six forms 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 July 31, 2013.
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: 2,920.
Total Responses: 2,920.
[[Page 15743]]
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Frequency of Number of
Form/Letter Time to complete response respondents Hours burden
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CA-5.................................. 90 min.................. 1 105 158
CA-5b................................. 90 min.................. 1 11 17
CA-1031............................... 20 min.................. 1 190 63
CA-1074............................... 60 min.................. 1 52 52
Student Dependency.................... 30 min.................. 1 1,514 757
Comp Due at Death..................... 30 min.................. 1 1,048 524
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Totals............................ ........................ .............. 2,920 1,571
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Estimated Total Burden Hours: 1,571.
Total Burden Cost (capital/startup): $1,431.
Total Burden Cost (operating/maintenance): $28,920.
Comments submitted in response to this notice will be summarized
and/or included in the request for Office of Management and Budget
approval of the information collection request; they will also become a
matter of public record.
Dated: March 5, 2013.
Yoon Ferguson,
Agency Clearance Officer, Office of Workers' Compensation Programs, US
Department of Labor.
[FR Doc. 2013-05590 Filed 3-11-13; 8:45 am]
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