Federal Register / Vol. 78, No. 209 / Tuesday, October 29, 2013 / Notices 64539 

mention OMB Control Number 1219– 

0138. The OMB 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–MSHA. 

Title of Collection: Safety Standards 

for Underground Coal Mine 

Ventilation—Belt Entry Used as an 

Intake Air Course to Ventilate Working 

Sections and Areas Where Mechanized 

Mining Equipment is Being Installed or 

Removed. 

OMB Control Number: 1219–0138. 

Affected Public: Private Sector— 

businesses or other for-profits. 

Total Estimated Number of 

Respondents: 21. 

Total Estimated Number of 

Responses: 251. 

Total Estimated Annual Burden 

Hours: 4,245. 

Total Estimated Annual Other Costs 

Burden: $40,664. 

Dated: October 22, 2013. 

Michel Smyth, 

Departmental Clearance Officer. 

[FR Doc. 2013–25393 Filed 10–28–13; 8:45 am] 

BILLING CODE 4510–43–P 

DEPARTMENT OF LABOR 

Office of the Secretary 

Agency Information Collection 

Activities; Submission for OMB 

Review; Comment Request; Energy 

Employees Occupational Illness 

Compensation Program Act Forms 

ACTION: Notice. 

SUMMARY: The Department of Labor 

(DOL) is submitting the Office of 

Workers’ Compensation Programs 

(OWCP) sponsored information 

collection request (ICR) revision titled, 

‘‘Energy Employees Occupational 

Illness Compensation Program Act 

Forms,’’ to the Office of Management 

and Budget (OMB) for review and 

approval for use in accordance with the 

Paperwork Reduction Act (PRA) of 1995 

(44 U.S.C. 3501 et seq.). 

DATES: Submit comments on or before 

November 29, 2013. 

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 of charge from the 

RegInfo.gov Web site at http://

www.reginfo.gov/public/do/

PRAViewICR?ref_nbr=201304-1240-001 

(this link will only become active on the 

day following publication of this notice) 

or by contacting Michel Smyth by 

telephone at 202–693–4129 (this is not 

a toll-free number) or sending an email 

to DOL_PRA_PUBLIC@dol.gov. 

Submit comments about this request 

to the Office of Information and 

Regulatory Affairs, Attn: OMB Desk 

Officer for DOL–OWCP, Office of 

Management and Budget, Room 10235, 

725 17th Street NW., Washington, DC 

20503, Fax: 202–395–6881 (this is not a 

toll-free number), email: OIRA_

submission@omb.eop.gov. Commenters 

are encouraged, but not required, to 

send a courtesy copy of any comments 

to the U.S. Department of LaborOASAM, Office of the Chief Information 

Officer, Attn: Information Management 

Program, Room N1301, 200 Constitution 

Avenue NW, Washington, DC 20210, 

email: DOL_PRA_PUBLIC@dol.gov. 

FOR FURTHER INFORMATION CONTACT: 

Contact Michel Smyth by telephone at 

202–693–4129 (this is not a toll-free 

number) or by email at DOL_PRA_

PUBLIC@dol.gov. 

Authority: 44 U.S.C. 3507(a)(1)(D). 

SUPPLEMENTARY INFORMATION: The 

OWCP is the primary agency 

responsible for administering the Energy 

Employees Occupational Illness 

Compensation Program Act of 2000, as 

amended (EEOICPA) (42 U.S.C. 7384 et 

seq.). The EEOICPA provides for timely 

payment of compensation to covered 

employees who sustained either 

occupational or otherwise covered 

illnesses incurred in the performance of 

duty for the Department of Energy 

(DOE) and certain of its contractors and 

subcontractors and, where applicable, 

survivors of such employees. The 

EEOICPA sets forth eligibility criteria 

for claimants for compensation under 

EEOICPA parts B and E and outlines the 

various elements of compensation 

payable from the Energy Employees 

Occupational Illness Compensation 

Fund. 

Regulations 20 CFR 30.100, –.101, 

–.102, –.103, –.111, –.112, –.113, –.114, 

–.206, –.207, –.212, –.213, –.214, –.215, 

–.221, –.222, –.226, –.231, –.232, –.415, 

–.416, –.417, –.505, –.620, –.806, –.905, 

and –.907 implementing the EEOICPA 

contain information collection 

requirements covered by this ICR. The 

OWCP also uses this ICR to obtain PRA 

authorization to implement the 

information collection requirement 

found at 42 U.S.C. 7385s–11. 

The OWCP uses forms covered by this 

ICR to determine a claimant’s eligibility 

for EEOICPA compensation and 

responses are required to obtain or 

retain benefits. The information 

collections in this ICR collect 

demographic, factual, and medical 

information needed to determine 

entitlement to EEOICPA benefits. Before 

the OWCP can pay benefits, the case file 

must contain medical and employment 

evidence showing the claimant’s 

eligibility. The various collections 

covered by this ICR and the purpose of 

each are listed below: 

Form EE–1—A living current or 

former employee completes the form to 

file a claim under parts B and/or E. The 

form requests information about the 

illness or illnesses being claimed and 

information about tort suits, settlements, 

or awards in litigation; State workers’ 

compensation benefits; and fraud 

convictions that affect entitlement. This 

form is also available in Spanish. (20 

CFR 30.100, –.103, –.505, and –.620.) 

Form EE–2—The survivor of a 

deceased employee uses the form to file 

a claim under parts B and/or E. The 

form requests information regarding 

both the survivor and the deceased 

employee. The form also requests 

information about illnesses, tort suits, 

settlements, or awards in litigation; 

State workers’ compensation benefits; 

and fraud convictions that affect 

entitlement. This form is also available 

in Spanish. (20 CFR 30.101, –.103, 

–.505, and –.620.) 

Form EE–3—The form gathers 

information about the employee’s work 

history. This form is also available in 

Spanish. (20 CFR 30.103, –.111, –.113, 

–.114, –.206, –.212, –.214, –.221, and 

–.231.) 

Form EE–4—The employee or 

survivor uses the form to support the 

claimed employment history by 

affidavit. This form is also available in 

Spanish. (20 CFR 30.103, –.111, –.113, 

–.114, –.206, –.212, –.214, –.221, and 

–.231.) 

Form EE–5A—A claimant must 

provide supplemental employment 

evidence to substantiate periods of 

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64540 Federal Register / Vol. 78, No. 209 / Tuesday, October 29, 2013 / Notices 

unverified employment. There is no 

standard form or format for the 

submission of this information. For 

purposes of identification only, this 

requirement has been designated Form 

EE–5A. (20 CFR 30.112.) 

Form EE–5B—A current or former 

DOE contractor provides information to 

substantiate periods of unverified 

employment. There is no standard form 

or format for the submission of the 

information. For purposes of 

identification only, this requirement has 

been designated Form EE–5B. (20 CFR 

30.106.) 

Form EE–7—The OWCP uses this 

form to inform an employee, survivor, 

or physician of the medical evidence 

needed to establish a diagnosis of an 

occupational illness under part B or a 

covered illness under part E. This form 

is also available in Spanish. (20 CFR 

30.103, –.207, –.215, –.222, –.232(a) and 

(b), –.415, –.416, and –.417.) 

Form EE–7A—A claimant is required 

to provide information about when an 

injury, illness, or disability is sustained 

because of an occupational illness under 

part B or a covered illness under part E. 

There is no standard form or format for 

the submission of this medical 

information. For purposes of 

identification only, this requirement has 

been designated Form EE–7A. (20 CFR 

30.207, –.215, –.222, –.226, and 

–.232(c).) 

Form EE–8—The OWCP sends this 

letter with enclosure EN–8 to a claimant 

to obtain information about an 

employee’s smoking history when lung 

cancer due to radiation is claimed. 

Department of Health and Human 

Services (HHS) guidelines require the 

OWCP to ask for information regarding 

the employee’s smoking history before 

the OWCP can determine the probability 

of causation for radiogenic lung cancer. 

(20 CFR 30.213.) 

Form EE–9—The OWCP sends this 

letter with enclosure EN–9 to a claimant 

to obtain information concerning the 

race or ethnicity of the employee when 

radiogenic skin cancer is claimed. HHS 

guidelines require the OWCP to ask for 

this particular information regarding the 

employee’s race/ethnicity before the 

OWCP can determine the probability of 

causation for radiogenic skin cancer. (20 

CFR 30.213.) 

Form EE–10—A covered part E 

employee who has received an award 

for wage-loss and/or impairment due to 

a covered illness uses this form to 

provide information needed to support 

a claim for an additional award for a 

subsequent calendar year of wage-loss 

and/or any additional impairment. (20 

CFR 30.102, –.103, and –.505.) 

Form EE–11A—The OWCP sends this 

letter about impairment benefits under 

part E with enclosure EN–11A to a 

claimant to obtain medical evidence 

needed to support an initial award for 

permanent impairment due to an 

accepted covered illness. (20 CFR 

30.905 and –.907.) 

Form EE–11B—The OWCP sends this 

letter with enclosure EE–11B to a part 

E claimant to obtain the factual and 

medical evidence necessary to support 

an initial award for wage-loss benefits 

due to an accepted covered illness. (20 

CFR 30.806.) 

Form EE–12—The OWCP sends this 

letter with enclosure EN–12 to a covered 

part B or E employee receiving medical 

benefits to collect updated information 

about settlements or awards in litigation 

and State workers’ compensation 

benefits that affect continuing 

entitlement. (20 CFR 30.100 and –.505.) 

Form EE–13—The OWCP sends this 

letter with enclosure EN–13 to a State 

workers’ compensation authority to 

identify covered part E employees 

receiving medical benefits who have 

also been awarded State workers’ 

compensation for their covered 

illnesses. (42 USC 7385s–11.) 

Form EE–16—The OWCP sends this 

letter with enclosure EN–16 to a 

claimant to verify/obtain updated 

information about tort suits, settlements, 

or awards in litigation; State workers’ 

compensation benefits; and fraud 

convictions that affect entitlement 

immediately prior to issuance of a 

recommended decision on the claim. 

(20 CFR 30.505 and –.620.) 

Form EE–20—The OWCP sends this 

letter with enclosure EN–20 to a 

claimant to obtain financial information 

necessary to pay approved claims under 

part B or E. (20 CFR 30.505 and –.620.) 

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. 

The DOL obtains OMB approval for 

this information collection under 

Control Number 1240–0002. This ICR 

has been classified as a revision, 

because—in accordance with 

Department of the Treasury guidance— 

Form EE–20 has been changed to delete 

the option to request payment by paper 

check. The current approval is 

scheduled to expire on October 31, 

2013; however, it should be noted that 

existing information collection 

requirements submitted to the OMB 

receive a month-to-month extension 

while they undergo review. New 

information collection requirements 

would only take effect upon OMB 

approval. For additional substantive 

information about this ICR, see the 

related notice published in the Federal 

Register on July 5, 2013 (78 FR 40513). 

Interested parties are encouraged to 

send comments to the OMB, Office of 

Information and Regulatory Affairs at 

the address shown in the ADDRESSES

section within 30 days of publication of 

this notice in the Federal Register. In 

order to help ensure appropriate 

consideration, comments should 

mention OMB Control Number 1240– 

0002. The OMB 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. 

Title of Collection: Energy Employees 

Occupational Illness Compensation 

Program Act Forms. 

OMB Control Number: 1240–0002. 

Affected Public: Individuals or 

Households; State, Local, and Tribal 

Governments; and Private Sector— 

businesses or other for-profits. 

Total Estimated Number of 

Respondents: 65,013. 

Total Estimated Number of 

Responses: 66,020. 

Total Estimated Annual Burden 

Hours: 23,190. 

Total Estimated Annual Other Costs 

Burden: $28,089. 

Dated: October 23, 2013. 

Michel Smyth, 

Departmental Clearance Officer. 

[FR Doc. 2013–25392 Filed 10–28–13; 8:45 am] 

BILLING CODE 4510–CR–P 

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