[Federal Register Volume 91, Number 22 (Tuesday, February 3, 2026)]
[Notices]
[Pages 4968-4969]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2026-02151]
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DEPARTMENT OF LABOR
Office of the Workers' Compensation Programs
[OMB Control No. 1240-0013]
Proposed Extension of a Currently Approved Information
Collection: Claim for Compensation by Dependents Information Reports
AGENCY: Office of Workers' Compensation Programs, Division of Federal
Employees' Compensation, (OWCP/DFEC) Labor.
ACTION: Request for public comments.
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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
request for comment to provide the general public and Federal agencies
with an opportunity to comment on proposed collections of information
in accordance with the Paperwork Reduction Act of 1995. This request
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, Division of
Federal Employees' Compensation, (OWCP/DFEC) is soliciting comments on
the information collection for the Claim for Compensation by Dependents
Information Reports, Form CA-5 and CA-5b, Form CA-1031, Form CA-1074,
and the Form Letter ``Compensation Due at Death''.
DATES: All comments must be received on or before April 6, 2026.
ADDRESSES: You may submit comment as follows. Please note that late,
untimely filed comments will not be considered.
Electronic Submissions: Submit electronic comments in the following
way:
Federal eRulemaking Portal: https://www.regulations.gov.
Follow the instructions for submitting comments for WCPO-2026-0034.
Comments submitted electronically, including attachments, to https://www.regulations.gov will be posted to
[[Page 4969]]
the docket, with no changes. Because your comment will be made public,
you are responsible for ensuring that your comment does not include any
confidential information that you or a third party may not wish to be
posted, such as your or anyone else's Social Security number or
confidential business information.
If your comment includes confidential information that you
do not wish to be made available to the public, submit the comment as a
written/paper submission.
Written/Paper Submissions: Submit written/paper submissions in the
following way:
Mail/Hand Delivery: Mail or visit DOL-OWCP/DFEC, Office of
Workers' Compensation Programs, Division of Federal Employees'
Compensation, U.S. Department of Labor, 200 Constitution Ave. NW, Room
S-3323, Washington, DC 20210.
OWCP/DFEC will post your comment as well as any
attachments, except for information submitted and marked as
confidential, in the docket at https://www.regulations.gov.
FOR FURTHER INFORMATION CONTACT: Anjanette Suggs, Office of Workers'
Compensation Programs (OWCP) at [email protected] @dol.gov
(email); (202) 354-9660 (phone).
SUPPLEMENTARY INFORMATION:
I. Background
The Office of Workers' Compensation Programs (OWCP) is the federal
agency responsible for determining entitlement to benefits under the
Federal Employees' Compensation Act. These forms are reviewed to verify
dependents/survivors. Benefit payments are then initiated, continued,
adjusted, or terminated accordingly. Without the information requested
by the forms, determinations regarding entitlement to benefits could
not be made, and OWCP could not ensure that compensation was paid to
the correct individuals at the correct rate. Failure to verify
dependent information could result in significant overpayment, which
would be very difficult to recover.
The forms included in this package are used to request information
for entitlement to claim benefits under the Federal Employees'
Compensation Act from federal employees/their dependents/survivors; to
prove continued eligibility for benefits; to show entitlement to
remaining compensation payments of a deceased employee; and to show
dependency. The following Codes of Federal Regulations for this OMB
apply to Claims for Compensation under the Federal Employees'
Compensation Act, as amended: 20 CFR 10.7, 10.105, 10.410, 10.413,
10.417, 10.535, 10.537. See 5 U.S.C. 8110, 8124, 8145, and 8149.
See: https://www.ecfr.gov/current/title-20/part-10.
See: https://www.dol.gov/owcp/dfec/regs/statutes/feca.htm.
II. Desired Focus of Comments
OWCP/DFEC is soliciting comments concerning the proposed
information collection related to the Request for Employment
Information. OWCP/DFEC is particularly interested in comments that:
Evaluate whether the collection of information is
necessary for the proper performance of the functions of the Agency,
including whether the information has practical utility;
Evaluate the accuracy of OWCP/DFEC's estimate of the
burden related to the information collection, including the validity of
the methodology and assumptions used in the estimate;
Suggest methods to enhance the quality, utility, and
clarity of the information to be collected; and
Minimize the burden of the information collection 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.
Documents related to this information collection request are
available at https://regulations.gov and at DOL-OWCP/DFEC located at
200 Constitution Ave. NW, Room S-3323, Washington, DC 20210. Questions
about the information collection requirements may be directed to the
person listed in the FOR FURTHER INFORMATION section of this notice.
III. Current Actions
This information collection request concerns the Claim for
Compensation by Dependents Information Reports, Form CA-5 and CA-5b,
Form CA-1031, Form CA-1074, and the Form Letter ``Compensation Due at
Death''. OWCP/DFEC has updated the data with respect to the number of
respondents, responses, burden hours, and burden costs supporting this
information collection request from the previous information collection
request.
Type of Review: Extension, without change of a currently approved
information collection.
Agency: Office of Workers' Compensation Programs, Division of
Federal Employees' Compensation, OWCP/DFEC.
OMB Number: 1240-0013.
Affected Public: Business or other for profits.
Number of Respondents: 1241.
Frequency: On Occasion.
Number of Responses: 1,241.
Annual Burden Hours: 1,063.
Annual Respondent or Recordkeeper Cost: $730.00.
OWCP/DFEC 1240-0013: OWCP/DFEC Claim for Compensation by a
Dependent Information Reports.
Comments submitted in response to this notice will be summarized in
the request for Office of Management and Budget approval of the
proposed information collection request; they will become a matter of
public record and will be available at https://www.reginfo.gov.
Anjanette Suggs,
Certifying Officer.
[FR Doc. 2026-02151 Filed 2-2-26; 8:45 am]
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