[Federal Register Volume 70, Number 106 (Friday, June 3, 2005)]
[Notices]
[Pages 32655-32656]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-11034]


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DEPARTMENT OF LABOR

Office of the Secretary


Submission for OMB Review: Comment Request

May 25, 2005.
    The Department of Labor (DOL) has submitted the following public 
information collection requests (ICRs) to the Office of Management and 
Budget (OMB) for review and approval in accordance with the Paperwork 
Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. chapter 35). A copy of 
each ICR, with applicable supporting documentation, may be obtained by 
contacting Darrin King on 202-693-4129 (this is not a toll-free number) 
or e-mail: [email protected].
    Comments should be sent to Office of Information and Regulatory 
Affairs, Attn: OMB Desk Officer for the Employment Standards 
Administration (ESA), Office of Management and Budget, Room 10235, 
Washington, DC 20503, 202-395-7316 (this is not a toll-free number), 
within 30 days from the date of this publication in the Federal 
Register.
    The OMB 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

[[Page 32656]]

other forms of information technology, e.g., permitting electronic 
submission of responses.
    Agency: Employment Standards Administration.
    Type of Review: Extension of currently approved collection.
    Title: Requests for Examination and/or Treatment.
    OMB Number: 1215-0066.
    Form Number: LS-1.
    Frequency: On occasion.
    Type of Response: Reporting.
    Affected Public: Individuals or households.
    Number of Respondents: 16,200.
    Annual Reponses: 101,250.
    Average Response Time: 65 minutes.
    Total Annual Burden Hours: 109,350.
    Total Annualized Capital/Startup Costs: $0.
    Total Annual Costs (Operating/Maintaining Systems or Purchasing 
Services): $40,500.
    Description: Under section 7 (33 U.S.C., chapter 18, section 907) 
of the Longshore Act the employer/insurance carrier is responsible for 
furnishing medical care for the injured employee for such period of 
time as the injury or recovery period may require. Form LS-1 serves two 
purposes: it authorizes the medical care and provides a vehicle for the 
treating physician to report the findings, treatment given and 
anticipated physical condition of the employee.

    Agency: Employment Standards Administration.
    Type of Review: Extension of currently approved collection.
    Title: Notice of Recurrence.
    OMB Number: 1215-0167.
    Form Number: CA-2a.
    Frequency: 1 time per recurrence.
    Type of Response: Reporting.
    Affected Public: Individuals or households.
    Number of Respondents: 708.
    Annual Reponses: 708.
    Average Response Time: 30 minutes.
    Total Annual Burden Hours: 354.
    Total Annualized Capital/Startup Costs: $0.
    Total Annual Costs (Operating/Maintaining Systems or Purchasing 
Services): $0.
    Description: In accordance with 5 CFR 10.121, this form is used by 
current, or occasionally former, Federal employees to claim wage loss 
or medical treatment resulting from a recurrence of a work-related 
injury while federally employed. The information is necessary to ensure 
the accurate payment of benefits.

Ira L. Mills,
Departmental Clearance Officer.
[FR Doc. 05-11034 Filed 6-2-05; 8:45 am]
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