[Federal Register Volume 82, Number 197 (Friday, October 13, 2017)]
[Notices]
[Pages 47772-47773]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-22163]


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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Division of Coal Mine Workers' Compensation; Proposed Extension 
of Existing Collection; Comment Request

ACTION: Notice.

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SUMMARY: Currently, the Office of Workers' Compensation Programs is 
soliciting comments concerning the proposed collection: Representative 
Payee Report (CM-623), Representative Payee Report, Short Form (CM-
623S) and Physician's/Medical Officer's Statement (CM-787). A copy of 
the proposed information collection request can be obtained by 
contacting the office listed below in the addresses section of this 
Notice. This program helps to ensure that 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 on respondents can be 
properly assessed.

DATES: Written comments must be submitted by December 12, 2017.

ADDRESSES: You may submit comments by mail, delivery service, or by 
hand to Ms. Yoon Ferguson, U.S. Department of Labor, 200 Constitution 
Ave. NW.,

[[Page 47773]]

Room S-3323, Washington, DC 20210; by fax to (202) 354-9647; or by 
Email to <a href="/cdn-cgi/l/email-protection#284e4d5a4f5d5b47460651474746684c4744064f475e"><span class="__cf_email__" data-cfemail="8aeceff8edfff9e5e4a4f3e5e5e4caeee5e6a4ede5fc">[email protected]</span></a>. Please use only one method of 
transmission for comments (mail/delivery, fax, or Email). Please note 
that comments submitted after the comment period will not be 
considered.

SUPPLEMENTARY INFORMATION: The Department of Labor, as part of its 
continuing effort to reduce paperwork and respondent burden, conducts a 
preclearance consultation program to provide the general public and 
Federal agencies with an opportunity to comment on proposed and/or 
continuing collections of information in accordance with the Paperwork 
Reduction Act of 1995 (PRA95).
    I. Background: The Division of Coal Mine Workers' Compensation 
administers the Black Lung Benefits Act (30 U.S.C. 901 et seq.) which 
provides benefits to coal miners totally disabled due to pneumoniosis, 
and their surviving dependents. The CM-623, Representative Payee Report 
is used to collect expenditure data regarding the disbursement of the 
beneficiary's benefits by the representative payee to assure that the 
beneficiary's needs are being met. The CM-623S, Representative Payee--
Short Form, is a shortened version of the CM-623 that is used when the 
representative payee is a family member residing with the beneficiary. 
Currently, the representative payee completes the CM-623/CM-623S to 
provide a final accounting of benefits received on behalf of the 
beneficiary. Commonly, final utilization is due to the death of the 
beneficiary or when there is a change in representative payee 
determination. The CM-787, Physician's/Medical Officer's Statement is 
used to gather information from the beneficiary's physician about the 
capability of the beneficiary to manage monthly benefits. This form is 
used by OWCP to determine if it is in the beneficiary's best interest 
to have his/her benefits managed by another party. The regulatory 
authority for collecting this information is in 20 CFR 725.506, 510, 
511, and 513. This information collection is currently approved for use 
through January 31, 2018.
    II. Review Focus: The Department of Labor 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 
submissions of responses.
    III. Current Actions: The Department of Labor seeks the approval 
for the extension of this currently-approved information collection in 
order to carry out its responsibility to administer the Black Lung 
Benefits Act.
    Agency: Office of Workers' Compensation Programs.
    Type of Review: Extension.
    Title: Representative Payee Report (CM-623), Representative Payee 
Report, Short Form (CM-623S) and Physician's/Medical Officer's 
Statement (CM-787).
    OMB Number: 1240-0020.
    Agency Number: CM-623, CM-623S and CM-787.
    Affected Public: Individuals or households, Business or other for-
profit and Not-for-profit institutions.

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                                  Time to        Frequency  of       Number of       Number of
            Form                 complete          response         respondents      responses     Hours burden
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CM-623......................              90  As Needed.........             300             300             450
CM-623S.....................              10  As Needed.........             325             325              54
CM-787......................              15  Once..............             700             700             175
                             -----------------------------------------------------------------------------------
    Totals..................  ..............  ..................           1,325           1,325             679
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    Total Respondents: 1,325.
    Total Annual Responses: 1,325.
    Average Time per Response: 31 minutes.
    Estimated Total Burden Hours: 679.
    Frequency: On occasion.
    Total Burden Cost (capital/startup): $0.
    Total Burden Cost (operating/maintenance): $0.
    Comments submitted in response to this notice will be summarized 
and/or included in the request for Office of Management and Budget 
approval of the information collection request; they will also become a 
matter of public record.

    Dated: October 3, 2017.
Yoon Ferguson,
Agency Clearance Officer, Office of Workers' Compensation Programs, 
U.S. Department of Labor.
[FR Doc. 2017-22163 Filed 10-12-17; 8:45 am]
 BILLING CODE 4510-CK-P


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