[Federal Register Volume 70, Number 36 (Thursday, February 24, 2005)]
[Notices]
[Pages 9109-9110]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-3491]


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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: FECA Medical Report Forms, 
Claim for Compensation (CA-7, CA-16, CA-17, CA-20, CA-1090, CA-1303, 
CA-1305, CA-1331, CA-1087, CA-1332, QCM Letters, OWCP-5a, OWCP-5b, and 
OWCP-5c). 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 April 25, 2005.

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: FECA Medical Report Forms (CA-16, CA-17, CA-
20, CA-1090, CA-1303, CA-1305, CAT-1331, CA-1087, CA-1332, QCM Letters, 
OWCP-5a, OWCP-5b, and OWCP-5c) and Claim for Compensation (CA-7).

I. Background

    The Office of Workers' Compensation Programs (OWCP) administers the 
Federal Employees' Compensation Act (FECA), 5 U.S.C. 8101 et seq. The 
statute provides for the payment of benefits for wage loss and/or for 
permanent impairment to a scheduled member, arising out of a work 
related injury or disease. The Act outlines the elements of pay which 
are to be included in an individual's pay rate, and sets forth various 
other criteria for determining eligibility to and the amount of 
benefits, including augmentation of basic compensation for individuals 
with qualifying dependents; a requirement to report any earnings during 
a period that compensation is claimed; a prohibition against concurrent 
receipt of FECA benefits and benefits from OPM or certain VA benefits; 
a mandate that money collected from a liable third party found 
responsible for the injury for which compensation has been paid be 
applied to benefits paid or payable. Before compensation may be paid, 
the case file must contain medical evidence showing that the claimant's 
disability is casually related to the claimants' federal employment. As 
a particular claim ages, there is a continuing need for updated 
information to support continuing benefits. The FECA Medical Report

[[Page 9110]]

Forms collect medical information from physicians which are necessary 
to determine entitlement to benefits under the Act. The CA-7, Claim for 
Compensation, requests information from the injured worker regarding 
pay rate, dependents, earnings, dual benefits, and third-party 
information. This information collection is currently approved for use 
through August 31, 2005.

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 of the extension of this 
information collection in order carry out its statutory responsibility 
to compensate injured employees under the provisions of the Act.
    Type of Review: Extension.
    Agency: Employment Standards Administration.
    Titles: Claim for Compensation, FECA Medical Reports.
    OMB Number: 1215-0103.
    Agency Numbers: FECA Medical Report Forms (CA-16, CA-17, CA-20, CA-
1090, CA-1303, CA-1305, CA-1331, CA-1087, CA-1332, QCM Letters, OWCP-
5a, OWCP-5b, and OWCP-5c) and Claim for Compensation (CA-7).
    Affected Public: Individuals or households; Business or other for-
profit; Federal Government.
    Total Respondents: 302,485.
    Total Annual Responses: 302,485.
    Estimated Total Burden Hours: 30,748.

 
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                                                                                      Average
                              Forms                                  Number of      minutes per    Burden  hours
                                                                    respondents      response
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CA-7............................................................             400              13              87
CA-16...........................................................         130,000               5          10,833
CA-17...........................................................          60,000               5           5,000
CA-20...........................................................          80,000               5           6,667
CA-1090.........................................................             325              10              54
CA-1303.........................................................           3,000              20           1,000
CA-1305.........................................................              10              20               3
CA-1331.........................................................             250               5              21
CA-1332.........................................................             500              30             250
QCM Letters.....................................................           1,000               5              83
OWCP-5a.........................................................           7,000              15           1,750
OWCP-5b.........................................................           5,000              15           1,250
OWCP-5c.........................................................          15,000              15           3,750
                                                                 -----------------
    Total.......................................................         302,485             163          30,748
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    Frequency: As needed.
    Total Burden Cost (capital/startup): $0.
    Total Burden Cost (operating/maintenance): $120,994.00.
    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: February 17, 2005.
Sue Blumenthal,
Acting Chief, Branch of Management Review and Internal Control, 
Division of Financial Management, Office of Management, Administration 
and Planning, Employment Standards Administration.
[FR Doc. 05-3491 Filed 2-23-05; 8:45 am]
BILLING CODE 4510-CH-P