[Federal Register Volume 79, Number 198 (Tuesday, October 14, 2014)]
[Notices]
[Pages 61655-61656]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-24278]


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DEPARTMENT OF LABOR

Office of the Secretary


Agency Information Collection Activities; Submission for OMB 
Review; Comment Request; Representative Payee Report, Representative 
Payee Report Short Form, and Physician's/Medical Officer's Statement

ACTION: Notice.

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SUMMARY: The Department of Labor (DOL) is submitting the Office of 
Workers' Compensation Programs (OWCP) sponsored information collection 
request (ICR) revision titled, ``Representative Payee Report, 
Representative Payee Report Short Form, and Physician's/Medical 
Officer's Statement,'' to the Office of Management and Budget (OMB) for 
review and approval for use in accordance with the Paperwork Reduction 
Act (PRA) of 1995 (44 U.S.C. 3501 et seq.). Public comments on the ICR 
are invited.

DATES: The OMB will consider all written comments that agency receives 
on or before November 13, 2014.

ADDRESSES: A copy of this ICR with applicable supporting documentation; 
including a description of the likely respondents, proposed frequency 
of response, and estimated total burden may be obtained free of charge 
from the RegInfo.gov Web site at http://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=201405-1240-004 (this link will only become active 
on the day following publication of this notice) or by contacting 
Michel Smyth by telephone at 202-693-4129, TTY 202-693-8064, (these are 
not toll-free numbers) or sending an email to [email protected].
    Submit comments about this request by mail or courier to the Office 
of Information and Regulatory Affairs, Attn: OMB Desk Officer for DOL-
OWCP, Office of Management and Budget, Room 10235, 725 17th Street NW., 
Washington, DC 20503; by Fax: 202-395-5806 (this is not a toll-free 
number); or by email: [email protected]. Commenters are 
encouraged, but not required, to send a courtesy copy of any comments 
by mail or courier to the U.S. Department of Labor-OASAM, Office of the 
Chief Information Officer, Attn: Departmental Information Compliance 
Management Program, Room N1301, 200 Constitution Avenue NW., 
Washington, DC 20210; or by email: [email protected].

FOR FURTHER INFORMATION CONTACT: Contact Michel Smyth by telephone at 
202-693-4129, TTY 202-693-8064, (these are not toll-free numbers) or 
sending an email to [email protected].

    Authority: 44 U.S.C. 3507(a)(1)(D).


SUPPLEMENTARY INFORMATION: This ICR seeks approval under the PRA for 
revisions to the Representative Payee Report, Representative Payee 
Report Short Form, and Physician's/Medical Officer's Statement 
information collection. Benefits due a DOL black lung beneficiary may 
be paid to a representative payee on behalf of the beneficiary when he 
or she is unable to manage the benefits due to incapability or 
incompetence or because the beneficiary is a minor. The

[[Page 61656]]

Representative Payee Report (Form CM-623) and Representative Payee 
Report Short Form (Form CM-623S) are used to ensure that benefits paid 
to a representative payee are used for the beneficiary's well-being. 
The Physician's/Medical Officer's Statement (Form CM-787) is used to 
determine the beneficiary's capability to manage monthly black lung 
benefits. While not expected to affect respondent burden, this ICR has 
been classified as a revision because of minor clarifications that 
should help claimants better understand what information to provide on 
the forms. The Black Lung Benefits Act authorizes this information 
collection. See 30 U.S.C. 921, 922.
    This information collection is subject to the PRA. A Federal agency 
generally cannot conduct or sponsor a collection of information, and 
the public is generally not required to respond to an information 
collection, unless it is approved by the OMB under the PRA and displays 
a currently valid OMB Control Number. In addition, notwithstanding any 
other provisions of law, no person shall generally be subject to 
penalty for failing to comply with a collection of information that 
does not display a valid Control Number. See 5 CFR 1320.5(a) and 
1320.6. The DOL obtains OMB approval for this information collection 
under Control Number 1240-0020. The current approval is scheduled to 
expire on October 31, 2014; however, the DOL notes that existing 
information collection requirements submitted to the OMB receive a 
month-to-month extension while they undergo review. New requirements 
would only take effect upon OMB approval. For additional substantive 
information about this ICR, see the related notice published in the 
Federal Register on May 21, 2014 (79 FR 29219).
    Interested parties are encouraged to send comments to the OMB, 
Office of Information and Regulatory Affairs at the address shown in 
the ADDRESSES section within thirty (30) days of publication of this 
notice in the Federal Register. In order to help ensure appropriate 
consideration, comments should mention OMB Control Number 1240-0020. 
The OMB is particularly interested in comments that:
     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: DOL-OWCP
    Title of Collection: Representative Payee Report, Representative 
Payee Report Short Form, and Physician's/Medical Officer's Statement.
    OMB Control Number: 1240-0020.
    Affected Public: Individuals or households and private sector--
businesses or other for-profits and not-for profit institutions.
    Total Estimated Number of Respondents: 2,100.
    Total Estimated Number of Responses: 2,100.
    Total Estimated Annual Time Burden: 1,642 hours.
    Total Estimated Annual Other Costs Burden: $0

    Dated: October 6, 2014.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2014-24278 Filed 10-10-14; 8:45 am]
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