[Federal Register Volume 88, Number 22 (Thursday, February 2, 2023)]
[Notices]
[Pages 7109-7110]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-02143]


-----------------------------------------------------------------------

DEPARTMENT OF LABOR

Office of the Workers' Compensation Programs


Agency Information Collection Activities; Comment Request; Claim 
for Compensation by Dependents Information Reports

AGENCY: Office of Workers' Compensation Programs, Division of Federal 
Employees', Longshore and Harbor Workers' Compensation--DFELHWC-FECA

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Department of Labor (DOL) is soliciting comments 
concerning a proposed extension for the authority to conduct the 
information collection request (ICR) titled, ``Claim for Compensation 
by Dependents Information Reports.'' This request is part of continuing 
Departmental efforts to reduce paperwork and respondent burden in 
accordance with the Paperwork Reduction Act of 1995 (PRA).

DATES: Consideration will be given to all written comments received by 
April 3, 2023.

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 by 
contacting Anjanette Suggs by telephone at 202-354-9660 or by email at 
[email protected].
    Submit written comments about, or requests for a copy of, this ICR 
by mail or courier to the U.S. Department of Labor, Office of Workers' 
Compensation Programs, Room S3323, 200 Constitution Avenue NW, 
Washington, DC 20210; by email: [email protected].

FOR FURTHER INFORMATION CONTACT: Contact Anjanette Suggs by telephone 
at 202-354-9660 or by email at [email protected].

SUPPLEMENTARY INFORMATION: The DOL, as part of continuing efforts to 
reduce paperwork and respondent burden, conducts a pre-clearance 
consultation program to provide the general public and Federal agencies 
an opportunity to comment on proposed and/or continuing collections of 
information before submitting them to the OMB for final approval. This 
program helps to ensure 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 can be properly assessed.
    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 Form CA-5b is used by other 
survivors. Form Letter CA-1031 is used in disability cases and provides 
information to determine whether a claimant is supporting a dependent 
and is entitled to additional compensation. Form Letter CA-1074 is a 
follow up to

[[Page 7110]]

CA-5b to request clarification of any information that is unclear and 
incomplete in the CA-5b. The Form Letter ``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 Form Letter ``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 July 31, 2023.
    This information collection is authorized by 5 CFR 1320.3(c)(3) and 
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 the OMB under 
the PRA approves it 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.
    Interested parties are encouraged to provide comments to the 
contact shown in the ADDRESSES section. Written comments will receive 
consideration, and summarized and included in the request for OMB 
approval of the final ICR. In order to help ensure appropriate 
consideration, comments should mention 1240-0013.
    Submitted comments will also be a matter of public record for this 
ICR and posted on the internet, without redaction. The DOL encourages 
commenters not to include personally identifiable information, 
confidential business data, or other sensitive statements/information 
in any comments.
    The DOL 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-Office of Workers' Compensation Programs.
    Type of Review: Extension.
    Title of Collection: Claim for Compensation by Dependents 
Information Reports.
    Forms: CA-5, CA-5b; Form Letters (CA-1031, CA-1074, Compensation 
Due at Death, and Student Dependency).
    OMB Control Number: 1240-0013.
    Affected Public: Individuals or Households.
    Number of Respondents: 1,241.
    Frequency: On occasion.
    Number of Responses: 1,241.
    Annual Burden Hours: 1,063.
    Annual Respondent or Recordkeeper Cost: $556.00.
    Authority: 44 U.S.C. 3506(c)(2)(A).

Anjanette Suggs,
Agency Clearance Officer.
[FR Doc. 2023-02143 Filed 2-1-23; 8:45 am]
BILLING CODE 4510-CH-P