[Federal Register Volume 81, Number 144 (Wednesday, July 27, 2016)]
[Notices]
[Page 49270]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-17725]


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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Proposed Collection; Comment Request

AGENCY: Division of Coal Mine Workers' Compensation, Office of Workers' 
Compensation Programs, Department of Labor.

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 September 26, 2016.

ADDRESSES: Ms. Yoon Ferguson, U.S. Department of Labor, 200 
Constitution Ave. NW., Room S-3323, Washington, DC 20210, telephone/fax 
(202) 354-9647, 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 December 
31, 2016.
    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: 1,100.
    Total Annual Responses: 1,100.
    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): $450.
    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: July 21, 2016.
Yoon Ferguson,
Agency Clearance Officer, Office of Workers' Compensation Programs, 
U.S. Department of Labor.
[FR Doc. 2016-17725 Filed 7-26-16; 8:45 am]
 BILLING CODE 4510-CK-P