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###### Department of Labor

###### Office of the Secretary

                    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 email:                     *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 a currently approved collection.                

*Title:*                     Request for Information on Earnings, Dual Benefits, Dependents and Third Party Settlements.                

*OMB Number:*                     1215-0151.                

*Form No.:*                     CA-1032.                

*Frequency:*                     Annually.                

*Type of Response:*                     Reporting.                

*Affected Public:*                     Individuals or households.                

*Number of Respondents:*                     50,000.                

*Annual Responses:*                     50,000.                

*Average Response Time:*                     20 minutes.                

*Annual Burden Hours:*                     16,667.                

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

*Total Annual Costs (operating/maintaining systems or purchasing services):*                     $20,000.                 

*Description:*                     The collection of this information is necessary under provisions of the Federal Employees' Compensation Act (FECA) which states: (1) Compensation must be adjusted to reflect a claimant's earnings while in receipt of benefits ( 5 U.S.C. 8106); (2) compensation is payable at the augmented rate of 75 percent only if the claimant has one or more dependents as defined by the FECA (5 U.S.C. 8110); (3) compensation may not be paid concurrently with certain benefits from other Federal Agencies, such as the Office of Personnel Management, Social Security, and the Veterans Administration (5 U.S.C. 8116); (4) compensation must be adjusted to reflect any settlement from a third party responsible for the injury for which the claimant is being paid compensation (5 U.S.C. 8132); (5) an individual convicted of any violation related to fraud in the application for, or receipt of, any compensation benefit, forfeits (as of the date of such conviction) any entitlement to such benefits, for any injury occurring on or before the date of conviction (5 U.S.C. 8148(a)); and, (6) no Federal compensation benefit can be paid to any individual for any period during which such individual is incarcerated for any felony offense (5 U.S.C. 8148(b)(1)). The information collected through Form CA-1032 is used to ensure that compensation being paid on the periodic roll is correct.                 

*Agency:*                     Employment Standards Administration.                 

*Type of Review:*                     Extension of a currently approved collection.                 

*Title:*                     Worker Information—Terms and Conditions of Employment.                 

*OMB Number:*                     1215-0187.                 

*Form No.*                     WH-516.                 

*Frequency:*                     On occasion.                 

*Type of Response:*                     Third party disclosure.                 

*Affected Public:*                     Farms; Business or other for-profit; and Individuals or households.                           ( print page 77271)    

*Number of Respondents:*                     129,000.                 

*Annual Responses:*                     1,594,800.                 

*Average Response Time:*                     32 minutes.                 

*Annual Burden Hours:*                     68,800.                 

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

*Total Annual Costs (operating/maintaining systems or purchasing services):*                     $43,060.                 

*Description:*                     Various sections of the Migrant and Seasonal Agricultural Worker Protection Act (MSPA), 29 U.S.C. 1801*et seq.*; require each farm labor contractor, agricultural employer and agricultural association to disclose employment terms and conditions in writing to: (a) Migrant agricultural workers at the time of recruitment (MSPA section 201(a)); (b) seasonal agricultural workers, upon request, at the time of hire (MSPA section 301(a)(1)); and (c) seasonal agricultural workers employed through a day-haul operation at the place of recruitment (MSPA section 301(a)(2)). MSPA sections 201(b) and 301(b) also require that each such respondent provide each migrant worker, upon request, a written statement of terms and conditions of employment. In addition, MSPA sections 201(g) and 301(f) require providing such information in English or, as necessary and reasonable, in a language common to the workers and that the U.S. Department of Labor (DOL) make forms available to provide such information. DOL prints and makes optional Form WH-516, Worker Information—Terms of Conditions of Employment, available for this purpose. MSPA sections 201(a)(8) and 301(a)(1)(H) require disclosure of certain information regarding State workers' compensation insurance to each migrant or seasonal agricultural worker (                    *i.e.*, whether State workers' compensation is provided and if so, the name of the State workers' compensation insurance carrier, the name of each person of the policyholder of such insurance, the name and the telephone number of each person who must be notified of an injury or death and the time period within which this notice must be given). Respondents may also meet this disclosure requirement, by providing the worker with a photocopy of any notice regarding workers' compensation insurance required by law of the state in which such worker is employed. The terms and conditions required to be disclosed to workers are set forth in sections 500.75(a) and (b) and 500.75(a), (b) and (c) of Regulations, 29 CFR part 500, Migrant and Seasonal Agricultural Worker Protection. Regulations 500.75(a) and 500.76(a) allow respondents to complete and disclose to workers the terms and conditions of employment using the DOL-developed optional form WH-516 to satisfy these requirements. Optional Form WH-516 may be used by the respondent to disclose employment terms and conditions in writing to migrant and seasonal agricultural workers.                 

Ira L. Mills, 

Departmental Clearance Officer. 

[FR Doc. 04-28190 Filed 12-23-04; 8:45 am] 

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