[Federal Register: February 14, 2005 (Volume 70, Number 29)]
[Notices]
[Page 7519-7520]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr14fe05-70]
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DEPARTMENT OF LABOR
Office of the Secretary; Submission for OMB Review: Comment
Request
February 3, 2005.
The Department of Labor (DOL) has submitted the following public
information collection requests (ICRs) to the Office of Management and
Budget (OMB) for review and approval in accordance with the Paperwork
Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. chapter 35). A copy of
each ICR, with applicable supporting documentation, may be obtained by
contacting Darrin King on 202-693-4129 (this is not a toll-free number)
or e-mail: king.darrin@dol.gov.
Comments should be sent to Office of Information and Regulatory
Affairs, Attn: OMB Desk Officer for the Employment Standards
Administration (ESA), Office of Management and Budget, Room 10235,
Washington, DC 20503, 202-395-7316 (this is not a toll-free number),
within 30 days from the date of this publication in the Federal
Register.
The OMB 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 submission of responses.
Agency: Employment Standards Administration.
Type of Review: Extension of currently approved collection.
Title: Certification of Funeral Expenses.
OMB Number: 1215-0027.
Form Number: LS-265.
Frequency: On occasion.
Type of Response: Reporting.
Affected Public: Business and other for-profit.
Number of Respondents: 195.
Annual Reponses: 195.
Average Response Time: 15 minutes.
Total Annual Burden Hours: 49.
Total Annualized Capital/Startup Costs: $0.
Total Annual Costs (operating/maintaining systems or purchasing
services): $78.00.
Description: The Office of Workers' Compensation Programs
administers the Longshore and Harbor Workers' Compensation Act. The Act
provides benefits to workers injured in maritime employment on the
navigable waters of the United States or in an adjoining area
customarily used by an employer in loading, unloading, repairing, or
building a vessel. The Act provides that reasonable funeral expenses
not to exceed $3,000 shall be paid in all compensable death cases. The
LS-265 has been provided for use in submitting the funeral expenses for
payment.
Agency: Employment Standards Administration.
Type of Review: Extension of currently approved collection.
Title: (1) Comparability of Current Work to Coal Mine Employment;
(2) Coal Mine Employment Affidavit; (3) Affidavit of Deceased Miner's
Condition.
OMB Number: 1215-0056.
Form Numbers: CM-913; CM-918; and CM-1093.
Frequency: On occasion.
Type of Response: Reporting.
Affected Public: Individuals or households.
Number of Respondents: 1,500.
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Average
Annual response Annual
Form responses time burden
(hours) hours
------------------------------------------------------------------------
CM-913.............................. 1,350 0.50 675
CM-918.............................. 75 0.17 13
CM-1093............................. 75 0.33 25
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Total............................. 1,500 .......... 713
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Total Annualized Capital/Startup Costs: $0.
Total Annual Costs (operating/maintaining systems or purchasing
services): $600.00.
Description: The Black Lung Benefits Act of 1977, as amended, 30
U.S.C. 901 et seq., provides for the payment of benefits to coal miners
who have contracted black lung disease as a result of coal mine
employment, and their dependents and survivors. Once a miner has been
identified as having performed non-coal mine work subsequent to coal
mine employment, the miner or the miner's survivor is asked to complete
a CM-913 to compare coal mine work to non-coal mine work. This
employment information along with medical information is used to
establish whether the miner is totally disabled due to black lung
disease caused by coal mine employment. The CM-918 is an affidavit used
to gather coal mine employment evidence only when primary evidence,
such as pay stubs, W-2 forms, employer and union records, and Social
Security records are unavailable or incomplete. The CM-1093 is an
affidavit form for recording lay medical evidence, used in survivors'
claims in which there is no medical evidence that addresses the miner's
pulmonary or respiratory condition.
Agency: Employment Standards Administration.
Type of Review: Revision of currently approved collection.
Title: Roentgenographic Interpretation (CM-933); Roentgenographic
Quality Rereading (CM-933b); Medical History and Examination for Coal
Mine Workers' Pneumoconiosis (CM-988); Report of Arterial Blood Gas
Study (CM-1159); and Report of Ventilatory Study (CM-2907).
OMB Number: 1215-0090.
[[Page 7520]]
Form Numbers: CM-933; CM-933b; CM-988; CM-1159; and CM-2907.
Frequency: On occasion.
Type of Response: Reporting.
Affected Public: Business and other for-profit and Not-for-profit
institutions.
Number of Respondents: 17,500.
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Number of Average
Form annual response time Annual burden
responses (hours) hours
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CM-933.......................................................... 3,500 0.08 292
CM-933b......................................................... 3,500 0.05 175
CM-988.......................................................... 3,500 0.50 1,750
CM-1159......................................................... 3,500 0.25 875
CM-2907......................................................... 3,500 0.33 1,167
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Total:...................................................... 17,500 .............. 4,259
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Total Annualized capital/startup costs: $0.
Total Annual Costs (operating/maintaining systems or purchasing
services): $0.
Description: The Black Lung Act Benefits Act of 1977 as amended, 30
U.S.C. 901 et seq. and 20 CFR 718.102 set forth criteria for the
administration and interpretation of x-rays. When a miner applies for
benefits, the Division of Coal Mine Workers' Compensation is required
to schedule a series of four diagnostic tests to help establish
eligibility for black lung benefits. Each of the diagnostic tests has
its own form that sets forth the medical results. The forms are: CM-
933, Roentgenographic Interpretation; CM-933b, Roentgenographic Quality
Rereading; CM-988, Medical History and Examination for Coal Mine
Workers' Pneumoconiosis; CM-1159, Report of Arterial Blood Gas Study;
and CM-2907, Report of Ventilatory Study.
The Department of Labor seeks the approval of this information in
order to carry out its responsibility to determine eligibility for
black lung benefits.
Ira L. Mills,
Departmental Clearance Officer.
[FR Doc. 05-2789 Filed 2-11-05; 8:45 am]
BILLING CODE 4510-23-P