86582 Federal Register / Vol. 85, No. 250 / Wednesday, December 30, 2020 / Notices 

December 19, 2020. The state will 

remain in an ‘‘off’’ period for a 

minimum of 13 weeks. 

• Based on the data submitted by 

Vermont for the week ending November 

28, 2020, Vermont’s 13-week IUR was 

4.90 percent, falling below the 5.0 

percent IUR threshold necessary to 

remain ‘‘on’’ EB. Therefore, the EB 

period for Vermont ends on December 

19, 2020. The state will remain in an 

‘‘off’’ period for a minimum of 13 

weeks. 

The trigger notice covering state 

eligibility for the EB program can be 

found at: http://ows.doleta.gov/ 

unemploy/claims_arch.as 

Information for Claimants 

The duration of benefits payable in 

the EB program, and the terms and 

conditions on which they are payable, 

are governed by the Federal-State 

Extended Unemployment Compensation 

Act of 1970, as amended, and the 

operating instructions issued to the 

states by the U.S. Department of Labor. 

In the case of a state beginning an EB 

period, the State Workforce Agency will 

furnish a written notice of potential 

entitlement to each individual who has 

exhausted all rights to regular benefits 

and is potentially eligible for EB (20 

CFR 615.13(c)(1)). 

Persons who believe they may be 

entitled to EB, or who wish to inquire 

about their rights under the program, 

should contact their State Workforce 

Agency. 

Signed in Washington, DC. 

John Pallasch, 

Assistant Secretary for Employment and 

Training. 

[FR Doc. 2020–28794 Filed 12–29–20; 8:45 am] 

BILLING CODE 4510–FW–P 

DEPARTMENT OF LABOR 

Office of Workers’ Compensation 

Programs 

Agency Information Collection 

Activities; Comment Request; 

Representative Payee Report, 

Representative Payee Report (Short 

Form), and Physician’s/Medical 

Officer’s Statement 

ACTION: Notice of availability; request 

for comments. 

SUMMARY: The Department of Labor 

(DOL) is soliciting comments 

concerning a proposed extension of the 

information collection request (ICR) 

titled, ‘‘Representative Payee Report, 

Representative Payee Report (Short 

Form), and Physician’s/Medical 

Officer’s Statement.’’ This comment 

request is part of continuing 

Departmental efforts to reduce 

paperwork and respondent burden in 

accordance with the Paperwork 

Reduction Act of 1995 (PRA). 

DATES: Consideration will be given to all 

written comments received by March 1, 

2021. 

ADDRESSES: A copy of this ICR with 

applicable supporting documentation; 

including a description of the likely 

respondents, proposed frequency of 

response, and estimated total burden 

may be obtained free by contacting 

Anjanette Suggs by telephone at (202) 

354–9660 (this is not a toll-free number) 

or by email at suggs.anjanette@dol.gov. 

Submit written comments about, or 

requests for a copy of, this ICR by mail 

or courier to the U.S. Department of 

Labor, Office of Workers’ Compensation 

Program, Division of Coal Mine 

Workers’ Compensation, Room N1301, 

200 Constitution Avenue NW, 

Washington, DC 20210; by email: 

suggs.anjanette@dol.gov. 

FOR FURTHER INFORMATION CONTACT: 

Contact Anjanette Suggs by telephone at 

(202) 354–9660 (this is not a toll-free 

number) or by email at suggs.anjanette@

dol.gov. 

SUPPLEMENTARY INFORMATION: The DOL, 

as part of continuing efforts to reduce 

paperwork and respondent burden, 

conducts a pre-clearance consultation 

program to provide the general public 

and Federal agencies an opportunity to 

comment on proposed and/or 

continuing collections of information 

before submitting them to the OMB for 

final approval. This program helps to 

ensure 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 can be properly 

assessed. 

Benefits due to a DOL Black Lung 

beneficiary are paid to a representative 

payee on behalf of the beneficiary when 

he or she is unable to manage the 

benefits due to incapability or 

incompetence or because the beneficiary 

is a minor. The Representative Payee 

Report (Form CM–623) and 

Representative Payee Report Short Form 

(Form CM–623S) are used to ensure that 

benefits paid to a representative payee 

are used for the beneficiary’s well-being. 

The Physician’s/Medical Officer’s 

Statement (Form CM–787) is used to 

determine the beneficiary’s capability to 

manage monthly black lung benefits. 

The Black Lung Benefits Act, 30 U.S.C. 

922, authorizes this information 

collection. 

This information collection is subject 

to the PRA. A Federal agency generally 

cannot conduct or sponsor a collection 

of information, and the public is 

generally not required to respond to an 

information collection, unless it is 

approved by the OMB under the PRA 

and displays a currently valid OMB 

Control Number. In addition, 

notwithstanding any other provisions of 

law, no person shall generally be subject 

to penalty for failing to comply with a 

collection of information that does not 

display a valid Control Number. See 5 

CFR 1320.5(a) and 1320.6. 

Interested parties are encouraged to 

provide comments to the contact shown 

in the ADDRESSES section. Comments 

must be written to receive 

consideration, and they will be 

summarized and included in the request 

for OMB approval of the final ICR. In 

order to help ensure appropriate 

consideration, comments should 

mention 1240–0020. 

Submitted comments will also be a 

matter of public record for this ICR and 

posted on the internet, without 

redaction. The DOL encourages 

commenters not to include personally 

identifiable information, confidential 

business data, or other sensitive 

statements/information in any 

comments. 

The DOL is particularly interested in 

comments that: 

• 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: DOL–OWCP. 

Type of Review: Extension. 

Title of Collection: Representative 

Payee Report, Representative Payee 

Report (Short Form), and Physician’s/ 

Medical Officer’s Statement. 

Form: Representative Payee Report 

(CM–623), Representative Payee Report 

(Short Form) (CM–623S) and 

Federal Register / Vol. 85, No. 250 / Wednesday, December 30, 2020 / Notices 86583 

Physician’s/Medical Officer’s Statement 

(CM–787). 

OMB Control Number: 1240–0020. 

Affected Public: Individuals or 

Households. 

Estimated Number of Respondents: 

1,325. 

Frequency: Annual. 

Total Estimated Annual Responses: 

1,325. 

Estimated Average Time per 

Response: Varies. 

Estimated Total Annual Burden 

Hours: 679 hours. 

Total Estimated Annual Other Cost 

Burden: $0. 

Authority: 44 U.S.C. 3506(c)(2)(A). 

Anjanette Suggs, 

Agency Clearance Officer. 

[FR Doc. 2020–28897 Filed 12–29–20; 8:45 am] 

BILLING CODE 4510–CK–P 

OFFICE OF PERSONNEL 

MANAGEMENT 

Submission for Review: Application for 

Refund of Retirement Deductions, SF 

3106 and Current/Former Spouse(s) 

Notification of Application for Refund 

of Retirement Deductions Under FERS, 

SF 3106A 

AGENCY: Office of Personnel 

Management. 

ACTION: 60-Day notice and request for 

comments. 

SUMMARY: Retirement Services, Office of 

Personnel Management (OPM) offers the 

general public and other federal 

agencies the opportunity to comment on 

a revised information collection request 

(ICR), Application for Refund of 

Retirement Deductions, Federal 

Employees Retirement System, SF 3106 

and Current/Former Spouse’s 

Notification of Application for Refund 

of Retirement Deductions under FERS, 

SF 3106A. 

DATES: Comments are encouraged and 

will be accepted until March 1, 2021. 

ADDRESSES: You may submit comments, 

identified by docket number and/or 

Regulatory Information Number (RIN) 

and title, by the following method: 

—Federal Rulemaking Portal:http://

www.regulations.gov. Follow the 

instructions for submitting comments. 

All submissions received must 

include the agency name and docket 

number or RIN for this document. The 

general policy for comments and other 

submissions from members of the public 

is to make these submissions available 

for public viewing at http://

www.regulations.gov as they are 

received without change, including any 

personal identifiers or contact 

information. 

FOR FURTHER INFORMATION CONTACT: A 

copy of this ICR with applicable 

supporting documentation, may be 

obtained by contacting the Retirement 

Services Publications Team, Office of 

Personnel Management, 1900 E Street 

NW, Room 3316–L, Washington, DC 

20415, Attention: Cyrus S. Benson, or 

sent via electronic mail to 

Cyrus.Benson@opm.gov or faxed to 

(202) 606–0910 or via telephone at (202) 

606–4808. 

SUPPLEMENTARY INFORMATION: As 

required by the Paperwork Reduction 

Act of 1995 (Pub. L. 104–13, 44 U.S.C. 

chapter 35) as amended by the ClingerCohen Act (Pub. L. 104–106), OPM is 

soliciting comments for this collection 

(OMB No. 3206–0121). The Office of 

Management and Budget is particularly 

interested in comments that: 

1. Evaluate whether the proposed 

collection of information is necessary 

for the proper performance of functions 

of the agency, including whether the 

information will have practical utility; 

2. 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; 

3. Enhance the quality, utility, and 

clarity of the information to be 

collected; and 

4. 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. 

Standard Form 3106, Application for 

Refund of Retirement Deductions under 

FERS is used by former Federal 

employees under FERS, to apply for a 

refund of retirement deductions 

withheld during Federal employment, 

plus any interest provided by law. 

Standard Form 3106A, Current/Former 

Spouse(s) Notification of Application 

for Refund of Retirement Deductions 

under FERS, is used by refund 

applicants to notify their current/former 

spouse(s) that they are applying for a 

refund of retirement deductions, which 

is required by law. 

Analysis 

Agency: Retirement Operations, 

Retirement Services, Office of Personnel 

Management. 

Title: Application for Refund of 

Retirement Deductions (FERS) and 

Current/Former Spouse’s Notification of 

Application for Refund of Retirement 

Deductions under FERS. 

OMB Number: 3206–0170. 

Frequency: On occasion. 

Affected Public: Individuals or 

Households. 

Number of Respondents: SF 3106 = 

8,000; SF 3106A = 6,400. 

Estimated Time per Respondent: SF 

3106 = 30 minutes; SF 3106A = 5 

minutes. 

Total Burden Hours: 4,533. 

Office of Personnel Management. 

Alexys Stanley, 

Regulatory Affairs Analyst. 

[FR Doc. 2020–28900 Filed 12–29–20; 8:45 am] 

BILLING CODE 6325–38–P 

OFFICE OF PERSONNEL 

MANAGEMENT 

Submission for Review: 3206–0121, 

Application for Deferred Retirement 

(for Persons Separated on or After 

October 1, 1956), OPM 1496A 

AGENCY: Office of Personnel 

Management. 

ACTION: 60-Day notice and request for 

comments. 

SUMMARY: Retirement Services, Office of 

Personnel Management (OPM) offers the 

general public and other federal 

agencies the opportunity to comment on 

a revised information collection request 

(ICR), Application for Deferred 

Retirement (for Persons Separated on or 

after October 1, 1956), OPM 1496A. 

DATES: Comments are encouraged and 

will be accepted until March 1, 2021. 

ADDRESSES: You may submit comments, 

identified by docket number and/or 

Regulatory Information Number (RIN) 

and title, by the following method: 

—Federal Rulemaking Portal: http://

www.regulations.gov. Follow the 

instructions for submitting comments. 

All submissions received must include 

the agency name and docket number or 

RIN for this document. The general 

policy for comments and other 

submissions from members of the public 

is to make these submissions available 

for public viewing at http://

www.regulations.gov as they are 

received without change, including any 

personal identifiers or contact 

information. 

FOR FURTHER INFORMATION CONTACT: A 

copy of this ICR with applicable 

supporting documentation, may be 

obtained by contacting the Retirement 

Services Publications Team, Office of 

Personnel Management, 1900 E Street 

NW, Room 3316–L, Washington, DC 

20415, Attention: Cyrus S. Benson, or