[Federal Register Volume 79, Number 211 (Friday, October 31, 2014)]
[Notices]
[Pages 64836-64837]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-25895]


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DEPARTMENT OF LABOR

Office of the Secretary


Agency Information Collection Activities; Submission for OMB 
Review; Comment Request; Federal Employees' Compensation Act Medical 
Report Forms, Claim for Compensation

ACTION: Notice.

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SUMMARY: On October 31, 2014, the Department of Labor (DOL) will submit 
the Office of Workers' Compensation Programs (OWCP) sponsored 
information collection request (ICR) revision titled, ``Federal 
Employees' Compensation Act Medical Report Forms, Claim for 
Compensation,'' 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 December 1, 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/

[[Page 64837]]

PRAViewICR?ref_nbr=201406-1240-002 (this link will only become active 
on November 1, 2014) 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: 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 Federal Employees' Compensation Act (FECA) medical 
report forms and claim for compensation information collection 
requirements. Forms CA-7, CA-16, CA-17, CA-20, CA-1331, CA-1332, OWCP-
5A, OWCP-5B, and OWCP-5C are used for filing claims for wage loss or 
permanent impairment due to a Federal employment-related injury and to 
obtain necessary medical documentation to determine whether a claimant 
is entitled to benefits under the FECA. This information collection has 
been classified as a revision, because of a change to the information 
collections needed to comply with current Federal law and FECA Bulletin 
No. 14-01, December 12, 2013. This change impacts augmented 
compensation, survivor benefits, death gratuity, schedule awards unpaid 
at death, and other Division of Federal Employees' Compensation 
administered benefits. Changes are also being made to comply with the 
Department of Treasury regulations requiring Federal payments to be 
made via electronic funds transfer instead of by paper checks. In 
addition, the forms now include an accommodation statement for 
claimants with mental and/or physical limitations to contact the OWCP 
if they need further assistance in the claims process. The OWCP has 
also provided additional guidance to physicians when determining work 
tolerance limitations to assist in return to work efforts. Finally, the 
ICR updates reference codes for diseases, signs and symptoms, abnormal 
findings, complaints, social circumstances, and external causes of 
injury or diseases.
    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 if the 
collection of information does not display a valid OMB Control Number. 
See 5 CFR 1320.5(a) and 1320.6. The DOL obtains OMB approval for this 
information collection under OMB Control Number 1240-0046. The current 
OMB approval is scheduled to expire on October 31, 2014; however, it 
should be noted that existing information collection requirements 
submitted to the OMB receive a month-to-month extension while they 
undergo review. For additional information, see the related notice 
published in the Federal Register on July 3, 2014 (79 FR 38072).
    Interested parties are encouraged to send comments to the OMB, 
Office of Information and Regulatory Affairs at the address shown in 
the ADDRESSES section by December 1, 2014. In order to help ensure 
appropriate consideration, comments should mention OMB Control Number 
1240-0046. 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: Federal Employees' Compensation Act Medical 
Report Forms, Claim for Compensation.
    OMB Control Number: 1240-0046.
    Affected Public: Individuals or Households.
    Total Estimated Number of Respondents: 282,353.
    Total Estimated Number of Responses: 282,353.
    Total Estimated Annual Time Burden: 25,605 hours.
    Total Estimated Annual Other Costs Burden: $110,118.

    Dated: October 27, 2014.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2014-25895 Filed 10-30-14; 8:45 am]
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