[Federal Register Volume 69, Number 45 (Monday, March 8, 2004)]
[Notices]
[Pages 10761-10762]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-5075]


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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: Survivor's Form for 
Benefits (CM-912). 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 7, 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

    This collection of information is required to administer the 
benefit payment provisions of the Black Lung Act for survivors of 
deceased miners. Form CM-912 is authorized for use by the Black Lung 
Benefits Act 30 U.S.C. 901, et seq., 20 CFR 410.221 and CFR 725.304. 
Completion of Form CM-912 constitutes the application for benefits by 
survivors and assists DCMWC in determining the survivor's entitlement 
to benefits. This information collection is currently approved for use 
through August 31, 2004.

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;

[[Page 10762]]

     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 extension of approval to collect 
this information in order to gather information to determine 
eligibility for benefits of a survivor of a Black Lung Act beneficiary.
    Type of Review: Extension.
    Agency: Employment Standards Administration.
    Title: Survivor's Form for Benefits.
    OMB Number: 1215-0069.
    Agency Number: CM-912.
    Affected Public: Individuals or households.
    Total Respondents: 2,800.
    Total Annual Responses: 2,800.
    Average Time per Response: 8 minutes.
    Estimated Total Burden Hours: 373.
    Frequency: One time.
    Total Burden Cost (Capital/Startup): $0.
    Total Burden Cost (Operating/Maintenance): $800.00.
    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 2, 2004.
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. 04-5075 Filed 3-5-04; 8:45 am]
BILLING CODE 4510-CH-P