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###### Department of Labor

###### Office of the Secretary

# ACTION:

Notice.

# SUMMARY:

The Department of Labor (DOL) is submitting the Office of Workers' Compensation Programs (OWCP) sponsored information collection request (ICR) revision titled, “Representative Payee Report, Representative Payee Report Short Form, and Physician's/Medical Officer's Statement,” 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.). Public comments on the ICR are invited.

# DATES:

The OMB will consider all written comments that agency receives on or before November 13, 2014.

# 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=​201405-1240-004*                         (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, TTY 202-693-8064, (these are not toll-free numbers) or sending an email to                         *DOL_PRA_PUBLIC@dol.gov.*

                        Submit comments about this request by mail or courier 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; by Fax: 202-395-5806 (this is not a toll-free number); or by email:                         *OIRA_submission@omb.eop.gov.*                         Commenters are encouraged, but not required, to send a courtesy copy of any comments by mail or courier to the U.S. Department of Labor-OASAM, Office of the Chief Information Officer, Attn: Departmental Information Compliance Management Program, Room N1301, 200 Constitution Avenue NW., Washington, DC 20210; or by email:                         *DOL_PRA_PUBLIC@dol.gov.*

# FOR FURTHER INFORMATION CONTACT:

                        Contact Michel Smyth by telephone at 202-693-4129, TTY 202-693-8064, (these are not toll-free numbers) or sending an email to                         *DOL_PRA_PUBLIC@dol.gov.*

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

# SUPPLEMENTARY INFORMATION:

                    This ICR seeks approval under the PRA for revisions to the Representative Payee Report, Representative Payee Report Short Form, and Physician's/Medical Officer's Statement information collection. Benefits due a DOL black lung beneficiary may be 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                           ( print page 61656)                        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. While not expected to affect respondent burden, this ICR has been classified as a revision because of minor clarifications that should help claimants better understand what information to provide on the forms. The Black Lung Benefits Act authorizes this information collection.                     *See*30 U.S.C. 921, 922.                

                    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 1240-0020. The current approval is scheduled to expire on October 31, 2014; however, the DOL notes that existing information collection requirements submitted to the OMB receive a month-to-month extension while they undergo review. New 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 May 21, 2014 (79 FR 29219).                

                    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 thirty (30) days of publication of this notice in the                     **Federal Register**                    . In order to help ensure appropriate consideration, comments should mention OMB Control Number 1240-0020. 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:*                     Representative Payee Report, Representative Payee Report Short Form, and Physician's/Medical Officer's Statement.                

*OMB Control Number:*                     1240-0020.                

*Affected Public:*                     Individuals or households and private sector—businesses or other for-profits and not-for profit institutions.                

*Total Estimated Number of Respondents:*                     2,100.                

*Total Estimated Number of Responses:*                     2,100.                

*Total Estimated Annual Time Burden:*                     1,642 hours.                

*Total Estimated Annual Other Costs Burden:*                     $0                

Dated: October 6, 2014.

Michel Smyth,

Departmental Clearance Officer.

[FR Doc. 2014-24278 Filed 10-10-14; 8:45 am]

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