[Federal Register Volume 76, Number 85 (Tuesday, May 3, 2011)]
[Notices]
[Pages 24919-24920]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-10611]


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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Division of Coal Mine Workers' Compensation Proposed Renewal of 
Existing 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 pre-clearance 
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: 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.

DATES: Written comments must be submitted to the office listed in the 
ADDRESSES section below on or before July 5, 2011.

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) 693-1447, E-mail [email protected]. 
Please use only one method of transmission for comments (mail, fax, or 
E-mail).

SUPPLEMENTARY INFORMATION: 
    I. Background: The Division of Coal Mine Workers' Compensation 
administers the Black Lung Benefits Act (30 U.S.C. 901 et seq.), which 
provides benefits to coal miners totally disabled due to pneumoniosis, 
and their surviving dependents. 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--
Short Form, is a shortened version of the CM-623 that is used when the 
representative payee is a family member residing with the beneficiary. 
The CM-787, Physician's/Medical Officer's Statement is used to gather 
information from the beneficiary's physician about the capability of 
the beneficiary to manage monthly benefits. This form 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 in 20 CFR 725.506, 510, 511, and 513. 
This information collection is currently approved for use through 
September 30, 2011.
    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

[[Page 24920]]

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 
for the extension of this currently-approved information collection in 
order to carry out its responsibility to administer the Black Lung 
Benefits Act.
    Agency: Office of Workers' Compensation Programs.
    Type of Review: Extension.
    Title: Representative Payee Report (CM-623), Representative Payee 
Report, Short Form (CM-623S) and Physician's/Medical Officer's 
Statement (CM-787).
    OMB Number: 1240-0020.
    Agency Number: CM-623, CM-623S and CM-787.
    Affected Public: Individuals or households, Business or other for-
profit and Not-for-profit institutions.

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                                                                                                        Number of         Number of
                     Form                       Time to complete        Frequency of response          respondents        responses       Hours burden
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CM-623........................................                90  Annually........................               900               900             1,350
CM-623S.......................................                10  Annually........................               100               100                17
CM-787........................................                15  Once............................             1,100             1,100               275
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    Totals....................................  ................  ................................             2,100             2,100             1,642
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    Total Respondents: 2,100.
    Total Annual Responses: 2,100.
    Average Time per Response: 46.9 minutes.
    Estimated Total Burden Hours: 1,642.
    Frequency: On occasion.
    Total Burden Cost (capital/startup): $0.
    Total Burden Cost (operating/maintenance): $0.
    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, 2011.
Vincent Alvarez,
Agency Clearance Officer, Office of Workers' Compensation Programs, 
U.S. Department of Labor.
[FR Doc. 2011-10611 Filed 5-2-11; 8:45 am]
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