Proposed Collection; Comment Request [11/24/2003]
Volume 68, Number 226, Page 65960-65961
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DEPARTMENT OF LABOR
Employment Standards Administration
Proposed Collection; 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) (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 Employment Standards Administration 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 23, 2004.
ADDRESSES: Ms. Hazel M. Bell, U.S. Department of Labor, 200
Constitution Ave., NW., Room S-3201, Washington, DC 20210, telephone (202) 693-0418, fax (202) 693-1451, e-mail bell.hazel@dol.gov. Please
use only one method of transmission for comments (mail, fax, or e-
mail).
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 beneficiary under the Federal
Employees' Compensation Act. There are six forms in this information
collection request. The information collected by Forms CA-5 and CA-5b,
is used by dependents for claiming compensation for the work related
death of a Federal Employee. Form CA-1031 is used in disability cases
and to determine whether a claimant is 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''
replaces Forms CA-1085 and CA-1093; this letter is used to request
information necessary to distribute compensation due when an employee
dies who was receiving or was entitled to compensation at the time of
death. The letter of ``Student/Dependency'' replaces Forms CA-1615, CA-
1617, and CA-1618; this letter is used to obtain information regarding
the student status of a dependent. This information collection is
currently approved for use through April 30, 2004.
II. Review Focus: The Department of Labor is particularly
interested in comments which:
[sbull] 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;
[sbull] 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;
[sbull] Enhance the quality, utility and clarity of the information
to be collected; and
[sbull] 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: Employment Standards Administration.
Title: Claim for Compensation by Dependents Information Reports.
OMB Number: 1215-0155.
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: 1,880.
Total Responses: 1,880.
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Minute per
Forms Respondents Frequency form Burden hours
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CA-5............................. 150.......................... Once 90 225
CA-5b............................ 20........................... Once 90 30
CA-1031.......................... 150.......................... Annually 15 37
CA-1074.......................... 10........................... Once 60 10
Student/Dependency............... 1,050........................ Semiannually 30 525
Compensation Due at Death........ 500.......................... Once 30 250
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Total........................ 1,880........................ .............. .............. 1,077
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Estimated Total Burden Hours: 1,077.
Total Burden Cost (capital/startup): $0.
Total Burden Cost (operating/maintenance): $431.
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: November 18, 2003.
Bruce Bohanon,
Chief, Branch of Management Review and Internal Control, Division of
Financial Management, Office of Management, Administration and
Planning, Employment Standards Administration.
[FR Doc. 03-29257 Filed 11-21-03; 8:45 am
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