[Federal Register Volume 63, Number 149 (Tuesday, August 4, 1998)]
[Notices]
[Pages 41594-41595]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-20796]


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DEPARTMENT OF LABOR

Office of the Secretary


Submission for OMB Review; Comment Request

July 29, 1998.
    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 individual ICR, with applicable supporting documentation, may be 
obtained by calling the Department of Labor, Departmental Clearance 
Officer, Todd R. Owen ({202} 219-5096 ext. 143) or by E-Mail to 
Owen0T<a href="/cdn-cgi/l/email-protection#751a111135111a195b121a03"><span class="__cf_email__" data-cfemail="274843436743484b09404851">[email protected]</span></a>.
    Comments should be sent to Office of Information and Regulatory 
Affairs, Attn: OMB Desk Officer for BLS, DM, ESA, ETA, MSHA, OSHA, 
PWBA, or VETS, Office of Management and Budget, Room 10235, Washington, 
DC 20503 ({202} 395-7316), on or before September 3, 1998. The OMB is 
particularly interested in comments which:
    <bullet> 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;
    <bullet> 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;
    <bullet> Enhance the quality, utility, and clarity of the 
information to be collected; and
    <bullet> 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 and Training Administration.
    Title: Alien Claims Activity Report.
    OMB Number: 1205-0268 (extension).
    Agency Number: ETA 9016.
    Frequency: quarterly.
    Affected Public: State, Local or Tribal Government.
    Number of Respondents: 53.
    Total Responses: 212.
    Estimated Time per Respondent: 1 hour.
    Total Burden Hours: 212.
    Total annualized capital/startup costs: 0.
    Total annual costs (operating/maintaining systems or purchasing 
services): 0.
    Description: The ETA 9016 allows assessment of cost efficiency of 
the Immigration and Naturalization Service verification system (SAVE) 
and allows the determination of the impact of the Immigration Reform 
and Control Act of the Unemployment Insurance system nationally.

    Agency: Employment Standards Administration.
    Title: Employer's First Report of Injury or Occupational Illness 
(LS-202); Physician's Report on Impairment of Vision (LS-205); 
Employer's Supplementary Report of Accident or Occupational Illness 
(LS-210).
    OMB Number: 1215-0031 (extension).
    Agency Numbers: LS-202, LS-205, LS-210.
    Frequency: On occasion.
    Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions.

------------------------------------------------------------------------
                                                       Average          
                                                      time per   Burden 
                  Form                   Respondents  response    hours 
                                                       (hours)          
------------------------------------------------------------------------
LS-202.................................      27,000        .25     6,750
LS-205.................................          90        .75        68
LS-210.................................       2,900        .25       725
------------------------------------------------------------------------

    Total Responses: 29,990.
    Total Burden Hours: 7,543.
    Total annualized capital/startup costs: 0.
    Total annual costs (operating/maintaining systems or purchasing 
services): $11,846.05.
    Description: The Longshore and Harbor Worker's Compensation Act 
provides benefits to workers injured in maritime employment on 
navigable waters of the United States or in an adjoining area 
customarily used by an employee in loading, unloading, repairing or 
building a vessel. The LS-202, Employer's First Report of Injury or 
Occupational Illness, is used by employers to report injuries that have 
occurred under the Longshore Act and its related statutes. The LS-210, 
Employer's Supplementary Report of Accident or Occupational Illness, is 
used to report additional periods of lost time from work. The LS-205, 
Physician's Report on Impairment of Vision, is a medical report based 
on a comprehensive examination of visual impairment.

    Agency: Employment Standards Administration.
    Title: Medical Travel Fund Request.
    OMB Number: 1215-0054 (extension).
    Agency Number: CM-957.
    Frequency: On occasion.
    Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions.
    Number of Respondents: 8,700.
    Total Responses: 8,700.
    Estimated Time per Respondent: 10 minutes.
    Total Burden Hours: 1,450.
    Total annualized capital/startup costs: 0.
    Total annual costs (operating/maintaining systems or purchasing 
services): $3,045.
    Description: When a coal miner files an application for black lung 
benefits under the Black Lung Benefits Act, the miner is scheduled for 
medical determination testing. The Black Lung Trust fund is required to 
pay for this determination testing and associated travel costs. The CM-
957 is used by the miner to record travel expenses incurred while 
traveling to and from the testing facility.

    Agency: Employment Standards Administration.
    Title: Request for State or Federal Worker's Compensation 
Information.
    OMB Number: 1215-0060 (extension).
    Agency Number: CM-905.
    Frequency: On occasion.
    Affected Public: Federal Government; State, Local or Tribal 
Government.
    Number of Respondents: 3,986.
    Total Responses: 3,986.
    Estimated Time per Respondent: 15 minutes.
    Total Burden Hours: 996 hours.
    Total annualized capital/startup costs: 0.
    Total annual costs (operating/maintaining systems or purchasing 
services): $1,395.00.

[[Page 41595]]

    Description: The Federal Mine Safety and Health Act of 1977, as 
amended, 30 U.S.C. 922(b) and 20 CFR 725.535, direct that the 
Department of Labor Black Lung benefit payments to a beneficiary for 
any month be reduced by any other payments of sate or federal benefits 
for workers compensation due to black lung disease. This form collects 
information regarding the status of any state or Federal workers' 
compensation claim, including dates of payments, weekly or lump sum 
amounts paid, and other fees or expenses paid out of this award, such 
as attorney fees and related expenses associated with black lung 
disease.

    Agency: Employment Standards Administration.
    Title: Notice of Law Enforcement Officer's Injury or Occupational 
Disease (CA-721); Notice of Law Enforcement Officer's Death (CA-722).
    OMB Number: 1215-0116 (extension).
    Agency Number: CA-721 and CA-722.
    Frequency: On occasion.
    Affected Public: Individuals or households; Business or other for-
profit; State, Local or Tribal Government.
    Number of Respondents: 63.
    Total Responses: 63.
    Estimated Time per Respondent: 60 minutes (CA-721); 90 minutes (CA-
722).
    Total Burden Hours: 87.
    Total annualized capital/startup costs: 0.
    Total annual costs (operating/maintaining systems or purchasing 
services): $30.45.
    Description: These forms are used for filing claims for 
compensation for injury and death to non-Federal law enforcement 
officers under the provisions of 5 U.S.C. 8191 et seq. The forms 
provide the basic information needed to process the claims made for 
injury or death.

    Agency: Employment Standards Administration.
    Title: Maintenance of Receipts for Benefits paid by a coal mine 
operator.
    OMB Number: 1215-0124 (extension).
    Agency Number: CM-200.
    Frequency: On occasion.
    Affected Public: Business or other for-profit; State, Local or 
Tribal Government.
    Number of Respondents: 150.
    Total Responses: 150.
    Total Burden Hours: 1 hour.
    Total annualized capital/startup costs: 0.
    Total annual costs (operating/maintaining systems or purchasing 
services): 0.
    Description: The Office of Workers' Compensation Program 
administers the Black Lung Benefits Act. Under 20 CFR 725.531, self-
insured coal mine operators or insurance carriers must maintain 
receipts for black lung benefit payments made for five years after the 
date on which the receipt was executed. This requirement is designated 
as CM-200, Maintenance of Receipts for Benefits Paid by a Coal Mine 
Operator. There is no form or format for the receipts; a canceled check 
will satisfy the requirement.

    Agency: Employment Standards Administration.
    Title: Rehabilitation Maintenance Certificate.
    OMB Number: 1215-0161 (extension).
    Agency Number: OWCP-17.
    Frequency: Every four weeks.
    Affected Public: Individuals or households; Businesses or other 
for-profit; Not-for-profit institutions; State, Local or Tribal.
    Number of Respondents: 1,300.
    Total Responses: 15,600.
    Estimated Time per Respondent: 10 minutes.
    Total Burden Hours: 2,605.
    Total annualized capital/startup costs: 0.
    Total annual costs (operating/maintaining systems or purchasing 
services): 0.
    Description: The Office of Workers' Compensation Program 
administers the Longshore and Harbor Workers' Compensation Act (LHWCA) 
and the Federal Employees' Compensation act (FECA). The Acts provide 
rehabilitation benefits to eligible injured workers. The Rehabilitation 
Maintenance Certificate is used to request reimbursement for expenses 
incurred as a result of an injured employee's participation in an 
approved rehabilitation effort.

    Agency: Mine Safety and Health Administration.
    Title: Certificate of Training.
    OMB Number: 1219-0070 (revision).
    Frequency: Annually.
    Affected Public: Business or other for-profit.
    Number of Respondents: 13,763.
    Total Responses: 633,098.
    Estimated Time per Respondent: .08 minutes.
    Total Burden Hours: 20,204.
    Total annualized capital/startup costs: 0.
    Total annual costs (operating/maintaining systems or purchasing 
services): $814,491.
    Description: Requires MSHA Form 5000-23, Certificate of Training, 
and Optional MSHA Form 5000-23T, Certificate of Task Training, to be 
used by mine operators to record mandatory training received by miners. 
The forms provide the mine operator with a recordkeeping form, the 
miner with a certificate of training, and MSHA with a monitoring tool 
for determining compliance requirements.
Todd R. Owen,
Departmental Clearance Officer.
[FR Doc. 98-20796 Filed 8-3-98; 8:45 am]
BILLING CODE 4510-27-M


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