[Federal Register Volume 75, Number 18 (Thursday, January 28, 2010)]
[Notices]
[Pages 4587-4588]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-1644]


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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Division of Federal Employees' Compensation; Proposed Extension 
of the Approval of Information Collection Requirements

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 Office of Workers' Compensation Programs is soliciting 
comments concerning the proposed collection: Claim for Compensation by 
Dependents Information Reports (CA-5, CA-5b, CA-1031, CA1074, Letter of 
Compensation Due at Death and Letter of Student/Dependency). 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 March 29, 2010.

ADDRESSES: Mr. Vincent Alvarez, U.S. Department of Labor, 200 
Constitution Ave., NW., Room S-3201, Washington, DC 20210, telephone 
(202) 693-0372, fax (202) 693-1378, E-mail [email protected]. 
Please use only one method of transmission for comments (mail, fax, or 
E-mail).

SUPPLEMENTARY INFORMATION:

I. Background

    The forms included in this package are forms used by Federal 
employees and their dependents to claim benefits, to prove continued 
eligibility for benefits, to show entitlement to remaining compensation 
payments of a deceased employee and to show dependency under the 
Federal Employees' Compensation Act. There are six forms in this 
information collection request. The information collected by Forms CA-
5, is used by dependents for claiming compensation for the work related 
death of a Federal Employee and CA-5b is used by other survivors. Form 
CA-1031 is used in disability cases and provides information to 
determine whether a claimant is actually supporting a dependent and is 
entitled to additional compensation. Form CA-1074 is a follow up to CA-
5b to request clarification of any information that is unclear and 
incomplete in the CA-5b. The letter of ``Compensation Due at Death'' is 
used to request information necessary to distribute compensation due 
when an employee dies who was receiving or who was entitled to 
compensation at the time of death for either disability benefits or a 
scheduled award. The letter of ``Student/Dependency'' is used to obtain 
information regarding the student status of a dependent. When a child 
reaches 18 years of age, they are no longer considered an eligible 
dependent unless they are a full time student or incapable of self-
support. This information collection is currently approved for use 
through May 31, 2010.

[[Page 4588]]

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 extension of approval to collect this 
information in order to carry out its responsibility to meet the 
statutory requirements of the Federal Employees' Compensation Act. The 
information contained in these forms is used by the Division of Federal 
Employees' Compensation to determine entitlement to benefits under the 
Act, to verify dependent status, and to initiate, continue, adjust, or 
terminate benefits based on eligibility criteria.
    Type of Review: Extension.
    Agency: Office of Workers' Compensation Programs.
    Title: Claim for Compensation by Dependents Information Reports.
    OMB Number: 1215-0155.
    Agency Number: CA-5, CA-5b, CA-1031, CA-1074, Letter of 
Compensation Due at Death and Letter of Student/Dependency.
    Affected Public: Individuals or households.
    Total Respondents: 1,358.
    Total Responses: 1,358.

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                                                      Time to      Frequency of      Number of
                   Form/letter                    complete (min)     response       respondents    Hours burden
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CA-5............................................              90               1             185             278
CA-5b...........................................              90               1              19              29
CA-1031.........................................              15               1             146              37
CA-1074.........................................              60               1              19              19
Student Dependency..............................              30               1             925             463
CompDue at Death................................              30               1              64              32
                                                 ---------------------------------------------------------------
    Totals......................................  ..............  ..............            1358             858
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    Estimated Total Burden Hours: 858.
    Total Burden Cost (capital/startup): $638.
    Total Burden Cost (operating/maintenance): $9,961.
    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: January 22, 2010.
Vincent Alvarez,
Agency Clearance Officer, Office of Workers' Compensation Programs, 
Department of Labor.
[FR Doc. 2010-1644 Filed 1-27-10; 8:45 am]
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