[Federal Register Volume 78, Number 33 (Tuesday, February 19, 2013)]
[Notices]
[Pages 11683-11684]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-03659]


-----------------------------------------------------------------------

DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Division of Federal Employees' Compensation, Proposed Extension 
of Existing Collection; Comment Request

ACTION: Notice.

-----------------------------------------------------------------------

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: Death Gratuity Forms (CA-
40, CA-41, and CA-42). 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 April 22, 2013.

ADDRESSES: Ms. Yoon Ferguson, U.S. Department of Labor, 200 
Constitution Ave. NW., Room S-32331, Washington, DC 20210, telephone 
(202) 693-0701, fax (202) 693-1447, Email [email protected]. Please 
use only one method of transmission for comments (mail, fax, or Email).

SUPPLEMENTARY INFORMATION: 
    I. Background: The National Defense Authorization Act for Fiscal 
Year 2008, Public Law 110-181, was enacted on January 28, 2008. Section 
1105 of Public Law 110-181 amended the Federal Employees' Compensation 
Act (FECA) creating a new 5 U.S.C. 8102a effective upon enactment. This 
section established a new FECA death gratuity

[[Page 11684]]

benefit for eligible beneficiaries of federal employees and Non-
Appropriated Fund Instrumentality (NAFI) employees who die from 
injuries incurred in connection with service with an Armed Force in a 
contingency operation. 5 U.S.C. 8102a permits agencies to authorize 
retroactive payment of the death gratuity for employees who died on or 
after October 7, 2001, in service with an Armed Force in the theater of 
operations of Operation Enduring Freedom and Operation Iraqi Freedom. 5 
U.S.C. 8102a also allows federal employees to vary the order of 
precedence of beneficiaries or to name alternate beneficiaries. Form 
CA-40 requests the information necessary from the employee to 
accomplish this variance. Form CA-41 provides the means for those named 
beneficiaries and possible recipients to file claims for those benefits 
and requests information from such claimants so that OWCP may determine 
their eligibility for payment. Furthermore, the statute and regulations 
require agencies to notify OWCP immediately upon the death of a covered 
employee. CA-42 provides the means to accomplish this notification and 
requests information necessary to administer any claim for benefits 
resulting from such a death. This information collection is currently 
approved for use through June 30, 2013.
    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: Death Gratuity Forms.
    OMB Number: 1240-0017.
    Agency Number: CA-40, CA-41, and CA-42.
    Affected Public: Individuals or household; Federal Government.
    Total Respondents: 272.
    Total Responses: 272.

----------------------------------------------------------------------------------------------------------------
                                      Time to
               Form                complete  (in   Frequency of      Number of       Number of     Hours burden
                                     minutes)        response       respondents      responses
----------------------------------------------------------------------------------------------------------------
CA-40 Individual Respondent.....              15               1             250             250              63
CA-41 Individual Respondent.....              15               1              11              11               3
CA-42 Agency Respondent.........              20               1              11              11               4
                                 -------------------------------------------------------------------------------
    Totals......................  ..............  ..............             272             272              70
----------------------------------------------------------------------------------------------------------------

    Estimated Total Burden Hours: 70.
    Total Burden Cost (capital/startup): $0.
    Total Burden Cost (operating/maintenance): $5.
    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: February 12, 2013.
Yoon Ferguson,
Agency Clearance Officer, Office of Workers' Compensation Programs, 
U.S. Department of Labor.
[FR Doc. 2013-03659 Filed 2-15-13; 8:45 am]
BILLING CODE 4510-CH-P