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###### Department of Labor

###### Office of the Secretary 

                    The Department of Labor (DOL) has submitted the following public information collection request (ICR) 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 this ICR, with applicable supporting documentation, may be obtained by contacting the Department of Labor (DOL). To obtain documentation, contact 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:*                     Application for Continuation of Death Benefit for Student.                 

*OMB Number:*                     1215-0073.                 

*Frequency:*                     On occasion.                 

*Type of Response:*                     Reporting.                 

*Affected Public:*                     Individuals or households; business or other for-profit; and not-for-profit institutions.                 

*Number of Respondents:*                     43.                 

*Annual Responses:*                     43.                 

*Average Response Time:*                     30 minutes.                 

*Annual Burden Hours:*                     22.                 

*Total Annualized capital/startup costs:*                     $0.                 

*Total Annual Costs (operating/maintaining systems or purchasing services):*                     $17.20.                 

*Description:*                     The Office of Workers' Compensation Programs administers the Longshore and Harbor Workers' Compensation Act. The Act provides for continuation of death benefits for a child or certain other surviving dependents after the age of 18 (to age 23) if the dependent qualifies as a student as defined in Section 2 (18) of the Act. Regulation 20 CFR 702.121 addresses the use of forms for the reporting of required information. The LS-266 is submitted by the parent or guardian of the dependent for whom continuation of benefits is sought. The statements contained on the form must be verified by an official of the educational institution. The information is used by the Department of Labor to determine whether a continuation of the benefits is justified.                 

Darrin A. King,

Acting Departmental Clearance Officer.

[FR Doc. 04-23801 Filed 10-22-04; 8:45 am] 

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