[Federal Register Volume 70, Number 85 (Wednesday, May 4, 2005)]
[Notices]
[Pages 23230-23231]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-8844]


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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: 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.

[[Page 23231]]


DATES: Written comments must be submitted to the office listed in the 
addresses section below on or before [insert date 60 days from the date 
of publication].

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 Office of Workers' Compensation Programs administers the 
Federal Black Lung Workers' Compensation Program. Under the Federal 
Mine Safety and Health Act (30 U.S.C. 901) benefits due a DOL black 
lung beneficiary may be paid to a representative payee on behalf of the 
beneficiary when the beneficiary is unable to manage his/her benefits 
due to incapability, incompetence, or minority. 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 Report, Short Form is a 
shortened version of the CM-623 that is used when the representative 
payee is a family member. The CM-787, Physician's/Medical Officer's 
Statement is a form used by OWCP to gather information from the 
beneficiary's physician about the capability of the beneficiary to 
manage monthly benefits. It 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 at 20 CFR 725.506, 510, 511, and 513. This information collection is 
currently approved for use through October 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 extension of approval to collect 
this information in order to carry out its responsibility to determine 
if a beneficiary is capable and/or competent to manage his/her black 
lung benefits, and to ensure that the representative payee is using the 
benefits to meet the beneficiary's needs.
    Type of Review: Extension.
    Agency: Employment Standards Administration.
    Title: Representative Payee Report (CM-623), Representative Payee 
Report, Short Form (CM-623S), and Physician's/Medical Officer's 
Statement (CM-787).
    OMB Number: 1215-0173.
    Agency Number: CM-623, CM-623S, and CM-787.
    Affected Public: Individuals or households; Business or other for 
profit, Not-for-profit institutions.
    Total Respondents: 5,339.
    Total Annual responses: 5,399.
    Estimated Total Burden Hours: 5,430.
    Frequency: On occasion.
    Total Burden Cost (capital/startup): $0.
    Total Burden Cost (operating/maintenance): $0.

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                                                 Respondents/
                     Forms                         responses            Time per response          Burden hours
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CM-623........................................           3,344  90 minutes......................           5,016
CM-623S.......................................           1,015  10 minutes......................             169
CM-787........................................             980  15 minutes......................             245
                                               -----------------
    Total.....................................           5,339  ................................           5,430
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    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: April 27, 2005.
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. 05-8844 Filed 5-3-05; 8:45 am]
BILLING CODE 4510-CK-P