Proposed Collection; Comment Request
[11/14/2006]
Volume 71, Number 219, Page 66351-66352
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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 16, 2007.
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, Email bell.hazel@dol.gov. Please
use only one method of transmission for comments (mail, fax, 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 forms 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-1032501 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 May 31, 2007.
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,
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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): $452.
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.
Hazel Bell,
Acting Chief, Branch of Management Review and Internal Control,
Division of Financial Management, Office of Management, Administration
and Planning, Employment Standards Administration.
[FR Doc. E6-19157 Filed 11-13-06; 8:45 am]
BILLING CODE 4510-CH-P
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