[Federal Register Volume 82, Number 197 (Friday, October 13, 2017)]
[Notices]
[Pages 47772-47773]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-22163]
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DEPARTMENT OF LABOR
Office of Workers' Compensation Programs
Division of Coal Mine Workers' Compensation; Proposed Extension
of Existing Collection; Comment Request
ACTION: Notice.
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SUMMARY: Currently, the Office of Workers' Compensation Programs is
soliciting comments concerning the proposed collection: Representative
Payee Report (CM-623), Representative Payee Report, Short Form (CM-
623S) and Physician's/Medical Officer's Statement (CM-787). A copy of
the proposed information collection request can be obtained by
contacting the office listed below in the addresses section of this
Notice. 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.
DATES: Written comments must be submitted by December 12, 2017.
ADDRESSES: You may submit comments by mail, delivery service, or by
hand to Ms. Yoon Ferguson, U.S. Department of Labor, 200 Constitution
Ave. NW.,
[[Page 47773]]
Room S-3323, Washington, DC 20210; by fax to (202) 354-9647; or by
Email to [email protected]. Please use only one method of
transmission for comments (mail/delivery, fax, or Email). Please note
that comments submitted after the comment period will not be
considered.
SUPPLEMENTARY INFORMATION: 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).
I. Background: The Division of Coal Mine Workers' Compensation
administers the Black Lung Benefits Act (30 U.S.C. 901 et seq.) which
provides benefits to coal miners totally disabled due to pneumoniosis,
and their surviving dependents. The CM-623, Representative Payee Report
is used to collect expenditure data regarding the disbursement of the
beneficiary's benefits by the representative payee to assure that the
beneficiary's needs are being met. The CM-623S, Representative Payee--
Short Form, is a shortened version of the CM-623 that is used when the
representative payee is a family member residing with the beneficiary.
Currently, the representative payee completes the CM-623/CM-623S to
provide a final accounting of benefits received on behalf of the
beneficiary. Commonly, final utilization is due to the death of the
beneficiary or when there is a change in representative payee
determination. The CM-787, Physician's/Medical Officer's Statement is
used to gather information from the beneficiary's physician about the
capability of the beneficiary to manage monthly benefits. This form is
used by OWCP to determine if it is in the beneficiary's best interest
to have his/her benefits managed by another party. The regulatory
authority for collecting this information is in 20 CFR 725.506, 510,
511, and 513. This information collection is currently approved for use
through January 31, 2018.
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 the approval
for the extension of this currently-approved information collection in
order to carry out its responsibility to administer the Black Lung
Benefits Act.
Agency: Office of Workers' Compensation Programs.
Type of Review: Extension.
Title: Representative Payee Report (CM-623), Representative Payee
Report, Short Form (CM-623S) and Physician's/Medical Officer's
Statement (CM-787).
OMB Number: 1240-0020.
Agency Number: CM-623, CM-623S and CM-787.
Affected Public: Individuals or households, Business or other for-
profit and Not-for-profit institutions.
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Time to Frequency of Number of Number of
Form complete response respondents responses Hours burden
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CM-623...................... 90 As Needed......... 300 300 450
CM-623S..................... 10 As Needed......... 325 325 54
CM-787...................... 15 Once.............. 700 700 175
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Totals.................. .............. .................. 1,325 1,325 679
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Total Respondents: 1,325.
Total Annual Responses: 1,325.
Average Time per Response: 31 minutes.
Estimated Total Burden Hours: 679.
Frequency: On occasion.
Total Burden Cost (capital/startup): $0.
Total Burden Cost (operating/maintenance): $0.
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: October 3, 2017.
Yoon Ferguson,
Agency Clearance Officer, Office of Workers' Compensation Programs,
U.S. Department of Labor.
[FR Doc. 2017-22163 Filed 10-12-17; 8:45 am]
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