[Federal Register Volume 78, Number 115 (Friday, June 14, 2013)]
[Notices]
[Page 35982]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-14103]


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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Division of Coal Mine Workers' Compensation; Proposed 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: Survivor's Form for 
Benefits (CM-912). 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 August 13, 2013.

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

SUPPLEMENTARY INFORMATION:
    I. Background: This collection of information is required to 
administer the benefit payment provisions of the Black Lung Act for 
survivors of deceased miners. Completion of this form constitutes the 
application for benefits by survivors and assists in determining the 
survivor's entitlement to benefits. Form CM-912 is authorized for use 
by the Black Lung Benefits Act 30 U.S.C. 901, et seq., 20 CFR 410.221 
and CFR 725.304 and is used to gather information from a survivor of a 
miner to determine if the survivor is entitled to benefits. This 
information collection is currently approved for use through October 
31, 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 the approval 
for the extension of this currently-approved information collection in 
order to gather information to determine eligibility for benefits of a 
survivor of a Black Lung Act beneficiary.
    Type of Review: Extension.
    Agency: Office of Workers' Compensation Programs.
    Title: Survivor's Form for Benefits.
    OMB Number: 1240-0027.
    Agency Number: CM-912.
    Affected Public: Individuals or households.
    Total Respondents: 1100.
    Total Annual Responses: 1100.
    Average Time per Response: 8 minutes.
    Estimated Total Burden Hours: 147.
    Frequency: One time.
    Total Burden Cost (capital/startup): $0.
    Total Burden Cost (operating/maintenance): $441.
    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: June 10, 2013.
Vincent Alvarez,
Agency Clearance Officer, Office of Workers' Compensation Programs, US 
Department of Labor.
[FR Doc. 2013-14103 Filed 6-13-13; 8:45 am]
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