[Federal Register Volume 84, Number 214 (Tuesday, November 5, 2019)]
[Notices]
[Pages 59652-59653]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-24083]


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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Proposed Extension of Existing Collection; Comment Request

AGENCY: Division of Federal Employees' Compensation, Office of Workers' 
Compensation Programs, Labor.

ACTION: Notice.

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SUMMARY: The Department of Labor (DOL), 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). This program helps to ensure that 
requested data can be provided in the desired format, reporting burden

[[Page 59653]]

(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 January 6, 2020.

ADDRESSES: You may submit comments by mail, delivery service, or by 
hand to Anjanette Suggs, U.S. Department of Labor, 200 Constitution 
Ave. NW, Room S-3323, Washington, DC 20210; by fax, (202) 354-9660, or 
email to [email protected]. Please use only one method of 
transmission for comments (mail or email).

SUPPLEMENTARY INFORMATION: 

I. Background

    The DOL is requesting an approval of an extension of this 
information collection. This information collection is essential to the 
mission of DOL and the Office of Workers' Compensation Programs (OWCP), 
the information collected through forms CA-40, CA-41 and CA-42 is used 
by claims examiners in OWCP to determine a person's entitlement to any 
or all of the death gratuity payment provided by 5 U.S.C. Sec.  8102a. 
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 section, 5 U.S.C. 8102a effective upon enactment. This section 
establishes a FECA death gratuity benefit of up to $100,000 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 also 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. 20 CFR 10.909 and 
10.911 provides that forms CA-40, CA-41, and CA-42 are used to 
designate beneficiaries and initiate the payment process for death 
gratuity benefits. See 5 U.S.C. 8145 and 8149.
    Form CA-40 is an optional form that requests the information 
necessary from the employee to accomplish this variance and to name 
alternate beneficiaries only if the employee wishes to do so. 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. Further, 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.

II. Review Focus

    The DOL 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 DOL seeks the approval for the extension of this currently 
approved information collection in order to carry out its 
responsibility to meet the statutory requirements of the Federal 
Employees' Compensation Act.
    Agency: Office of Workers' Compensation Programs.
    Type of Review: Extension.
    Title: Death Gratuity Forms.
    OMB Number: 1240-0017.
    Agency Number: CA-40, CA-41, and CA-42.
    Affected Public: Individuals or households; Businesses or other 
for-profit.
    Total Respondents: 4.
    Total Annual Responses: 4.
    Estimated Total Burden Hours: 3.
    Estimated Time per Response: 30 minutes.
    Frequency: On occasion.
    Total Burden Cost (capital/startup): $84.
    Total Burden Cost (operating/maintenance): $2.
    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.

Anjanette Suggs,
Agency Clearance Officer, Office of Workers' Compensation Programs, 
U.S. Department of Labor.
[FR Doc. 2019-24083 Filed 11-4-19; 8:45 am]
 BILLING CODE 4510-CH-P