[Federal Register Volume 68, Number 226 (Monday, November 24, 2003)]
[Notices]
[Pages 65960-65961]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-29257]


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DEPARTMENT OF LABOR

Employment Standards Administration


Proposed 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 Employment Standards Administration 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 23, 2004.

ADDRESSES: Ms. Hazel M. Bell, U.S. Department of Labor, 200 
Constitution Ave., NW., Room S-3201, Washington, DC 20210, telephone 
(202) 693-0418, fax (202) 693-1451, e-mail [email protected]. Please 
use only one method of transmission for comments (mail, fax, or e-
mail).

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 beneficiary under the Federal 
Employees' Compensation Act. There are six forms in this information 
collection request. The information collected by Forms CA-5 and CA-5b, 
is used by dependents for claiming compensation for the work related 
death of a Federal Employee. Form CA-1031 is used in disability cases 
and to determine whether a claimant is 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'' 
replaces Forms CA-1085 and CA-1093; this letter is used to request 
information necessary to distribute compensation due when an employee 
dies who was receiving or was entitled to compensation at the time of 
death. The letter of ``Student/Dependency'' replaces Forms CA-1615, CA-
1617, and CA-1618; this letter is used to obtain information regarding 
the student status of a dependent. This information collection is 
currently approved for use through April 30, 2004.
    II. Review Focus: The Department of Labor is particularly 
interested in comments which:
    [sbull] 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;
    [sbull] 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;
    [sbull] Enhance the quality, utility and clarity of the information 
to be collected; and
    [sbull] 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: Employment Standards Administration.
    Title: Claim for Compensation by Dependents Information Reports.
    OMB Number: 1215-0155.
    Agency Number: CA-5, CA-5b, CA-1031, CA-1074, Letter of 
Compensation Due at Death and Letter of Student/Dependency.
    Affected Public: Individuals or households.
    Total Respondents: 1,880.
    Total Responses: 1,880.

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                                                                                    Minute  per
              Forms                         Respondents              Frequency         form        Burden hours
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CA-5.............................  150..........................            Once              90             225
CA-5b............................  20...........................            Once              90              30
CA-1031..........................  150..........................        Annually              15              37
CA-1074..........................  10...........................            Once              60              10
Student/Dependency...............  1,050........................    Semiannually              30             525
Compensation Due at Death........  500..........................            Once              30             250
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[[Page 65961]]

 
    Total........................  1,880........................  ..............  ..............           1,077
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    Estimated Total Burden Hours: 1,077.
    Total Burden Cost (capital/startup): $0.
    Total Burden Cost (operating/maintenance): $431.
    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: November 18, 2003.
Bruce Bohanon,
Chief, Branch of Management Review and Internal Control, Division of 
Financial Management, Office of Management, Administration and 
Planning, Employment Standards Administration.
[FR Doc. 03-29257 Filed 11-21-03; 8:45 am]
BILLING CODE 4510-CH-P