[Federal Register Volume 70, Number 130 (Friday, July 8, 2005)]
[Notices]
[Pages 39529-39530]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-13417]


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DEPARTMENT OF LABOR

Office of the Secretary


Submission for OMB Review: Comment Request

June 27, 2005.
    The Department of Labor (DOL) has submitted the following public 
information collection request (ICR) 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 
this 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 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: FECA Medical Report Forms, Claim for Compensation.
    OMB Number: 1215-0103.
    Frequency: As needed and annually.
    Type of Response: Reporting.
    Affected Public: Individuals or households; business or other for-
profit; and Federal government.
    Number of Respondents: 287,660.

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                                                                     Estimated        Average        Estimated
                            Form No.                                  annual       response time   annual burden
                                                                     responses        (hours)          hours
----------------------------------------------------------------------------------------------------------------
CA-7............................................................             400            0.22              87
CA-16...........................................................         130,000            0.08          10,833
CA-17...........................................................          60,000            0.08           5,000
CA-20...........................................................          80,000            0.08           6,667
CA-1332.........................................................             500            0.50             250
CA-1090.........................................................             325            0.17              54
CA-1303.........................................................           3,000            0.33           1,000
CA-1305.........................................................              10            0.33               3
CA-1331 / CA-1087...............................................             250            0.08              21
QCM*-Letters....................................................           1,000            0.08              83
OWCP-5a.........................................................           7,000            0.25           1,750
OWCP-5b.........................................................           5,000            0.25           1,250
OWCP-5c.........................................................          15,000            0.25           3,750
                                                                 -----------------
    TOTAL:......................................................         302,485  ///////////////        30,748
                                                                                       //////
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*Quality Case Management


[[Page 39530]]

    Total Annualized capital/startup costs: $0.
    Total Annual Costs (operating/maintaining systems or purchasing 
services): $120,994.
    Description: These forms are used for filing claims for wage loss 
or permanent impairment due to a Federal employment-related injury, and 
to obtain necessary medical documentation to determine whether a 
claimant is entitled to benefits under the Federal Employees' 
Compensation Act, 5 U.S.C. 8101 et seq.

Ira L. Mills,
Departmental Clearance Officer.
[FR Doc. 05-13417 Filed 7-7-05; 8:45 am]
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