[Federal Register Volume 84, Number 217 (Friday, November 8, 2019)]
[Notices]
[Pages 60457-60458]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-24359]


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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Proposed Extension of Existing Collections; 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 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 (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: Claim for Compensation by Dependents Information Reports 
(CA-5, CA-5b, CA-1031, CA-1074, Letter of Compensation Due at Death, 
and Letter of Student/Dependency). 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 7, 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 forms included in this 
package are forms used by Federal employees and their dependents to 
claim benefits, to prove continued eligibility for benefits, to show 
entitlement to remaining compensation payments of a deceased employee 
and to show dependency under the Federal Employees' Compensation Act. 
There are six items in this information collection request. The 
information collected by Forms CA-5, is used by dependents for claiming 
compensation for the work related death of a Federal Employee and CA-5b 
is used by other survivors. Form CA-1031 is used in disability cases 
and provides information to determine whether a claimant is actually 
supporting a dependent and is entitled to additional compensation. Form 
CA-1074 is a follow up to CA-5b to request clarification of any 
information that is unclear and incomplete in the CA-5b. The letter of 
``Compensation Due at Death'' is used to request information necessary 
to distribute compensation due when an employee dies who was receiving 
or who was entitled to compensation at the time of death for either 
disability benefits or a scheduled award. The letter of ``Student/
Dependency'' is used to obtain information regarding the student status 
of a dependent. When a child reaches 18 years of age, they are no 
longer considered an eligible dependent unless they are a full time 
student or incapable of self-support. This information collection is 
currently approved for use through August 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 extension of 
approval to collect this information in order to carry out its 
responsibility to meet the statutory requirements of the Federal 
Employees' Compensation Act. The information contained in these forms 
is used by the Division of Federal Employees' Compensation to determine 
entitlement to benefits under the Act, to verify dependent status, and 
to initiate, continue, adjust, or terminate benefits based on 
eligibility criteria.
    Type of Review: Extension.
    Agency: Office of Workers' Compensation Programs.
    Title: Claim for Compensation by Dependents Information Reports.
    OMB Number: 1240-0013.
    Agency Number: CA-5, CA-5b, CA-1031, CA-1074, Letter of 
Compensation Due at Death, and Letter of Student/Dependency.
    Affected Public: Individuals or households.
    Total Respondents: 933.
    Total Responses: 933.

[[Page 60458]]



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                                                      Time to
                   Form/letter                       complete      Frequency of      Number of     Hours burden
                                                     (minutes)       response       respondents
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CA-5/5b.........................................              90               1             333             500
CA-1031.........................................              20               1              38              13
CA-1074.........................................              60               1              10              10
Student Dependency..............................              30               1             299             150
Comp Due at Death...............................              30               1             253             127
                                                 ---------------------------------------------------------------
    Totals......................................  ..............  ..............             933             800
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    Estimated Total Burden Hours: 800.
    Total Burden Cost (capital/startup): $0.
    Total Burden Cost (operating/maintenance): $541.
    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.

Ajanette Suggs,
Agency Clearance Officer, Office of Workers' Compensation Programs, 
U.S. Department of Labor.
[FR Doc. 2019-24359 Filed 11-7-19; 8:45 am]
 BILLING CODE 4510-CH-P