Federal Register / Vol. 82, No. 197 / Friday, October 13, 2017 / Notices 47773 

Room S–3323, Washington, DC 20210; 

by fax to (202) 354–9647; or by Email to 

ferguson.yoon@dol.gov. 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. 

Form Time to 

complete 

Frequency 

of response 

Number of 

respondents 

Number of 

responses Hours burden 

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 

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 

DEPARTMENT OF LABOR 

Office of Workers’ Compensation 

Programs 

Division of Coal Mine Workers’ 

Compensation; Proposed Extension of 

Existing Collection; Comment Request 

ACTION: Notice. 

SUMMARY: Currently, the Office of 

Workers’ Compensation Programs is 

soliciting comments concerning the 

proposed collection: Report of Changes 

that May Affect Your Black Lung 

Benefits (CM–929 and CM–929P). 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., 

Room S–3323, Washington, DC 20210; 

by fax to (202) 354–9647; or by Email to 

ferguson.yoon@dol.gov. 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 


asabaliauskas on DSKBBXCHB2PROD with NOTICES
47774 Federal Register / Vol. 82, No. 197 / Friday, October 13, 2017 / Notices 

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 Black Lung 

Benefits Act, 30 U.S.C. 901 et seq., 30 

U.S.C. 936 and 941, and its 

implementing requlations, 20 CFR 

725.533(e), authorizes the Division of 

Coal Mine Workers’ Compensation 

(DCMWC) to collect information 

regarding payments of compensation to 

coal miners and other beneficiaries. 

Once a miner or survivor is found 

eligible for benefits, the primary 

beneficiary is requested to report certain 

changes that may affect benefits. To 

ensure that there is a review and update 

of all claims paid from the Black Lung 

Disability Trust Fund, and from Social 

Security cases transferred to the 

Department of Labor under the Black 

Lung Consolidation of Administrative 

Responsibilities Act of 2002, and to help 

the beneficiary comply with the need to 

report certain changes, the CM–929 is 

sent to all appropriate primary 

beneficiaries. The CM–929 is printed by 

the DCMWC computer system with 

information specific to each beneficiary, 

such as name, address, number of 

dependents on record, state workers’ 

compensation information, and amount 

of current benefits. The beneficiary 

reviews the information and certifies 

that the information is current, or 

provides updated information. The form 

includes a warning about potential 

consequences of failure to report 

changes. 

The CM–929P is sent to all 

beneficiaries who have a representative 

payee. Compensation is paid to a 

representative payee on behalf of the 

beneficiary when the beneficiary is 

unable to manage his/her benefits due to 

incapability, incompetence or minority. 

The CM–929P is printed by the DCMWC 

computer system with information 

specific to each beneficiary, such as 

name, address, number of dependents 

on record, state workers’ compensation 

information, and amount of benefits. 

Additionally, representative payees are 

requested to provide information 

regarding the use of benefits received, 

where the beneficiary lives, and 

ensuring the needs of the beneficiary are 

being met. The representative payee 

reviews the information specific to the 

beneficiary, as well as provides their 

accounting of the funds received, and 

certifies that all information is current 

or provides updated information. The 

form includes a warning about potential 

consequences of failure to report 

changes. 

This information collection is 

currently approved for use through 

December 31, 2017. 

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 verify 

the accuracy of information in the 

beneficiary’s claims file, to identify 

changes in the beneficiary’s status, to 

ensure that the amount of compensation 

being paid the beneficiary is accurate, 

and to verify that a representative payee 

is using benefits received to meet the 

beneficiary’s needs. 

Agency: Office of Workers’ 

Compensation Programs. 

Type of Review: Extension. 

Title: Report of Changes That May 

Affect Your Black Lung Benefits. 

OMB Number: 1240–0028. 

Agency Number: CM–929 and CM– 

929P. 

Affected Public: Individuals and Notfor-profit institutions. 

Form 

Time to 

complete 

(minutes) 

Frequency of response 

(minutes) 

Number 

of respondents 

Number 

of responses Hours burden 

CM–929 ............................................. 5–8 Annually ............................................ 26,000 26,000 1,999 

CM–929P .......................................... 6–80 Annually ............................................ 3,380 3,380 4,090 

Totals ......................................... 12 ........................................................... 29,380 29,380 6,089 

Total Respondents: 29,380. 

Total Annual Responses: 29,380. 

Average Time per Response: 12 

minutes. 

Estimated Total Burden Hours: 6,089. 

Frequency: Annually. 

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, US Department of 

Labor. 

[FR Doc. 2017–22164 Filed 10–12–17; 8:45 am] 

BILLING CODE 4510–CK–P 

NATIONAL AERONAUTICS AND 

SPACE ADMINISTRATION 

[Notice 17–075] 

Notice of Information Collection 

AGENCY: National Aeronautics and 

Space Administration (NASA). 

ACTION: Notice of information collection. 

SUMMARY: The National Aeronautics and 

Space Administration, as part of its 

continuing effort to reduce paperwork 

and respondent burden, invites the 

general public and other Federal 

agencies to take this opportunity to 

comment on proposed and/or 

continuing information collections, as 

required by the Paperwork Reduction 

Act of 1995. 

DATES: All comments should be 

submitted within 30 calendar days from 

the date of this publication. 

ADDRESSES: Interested persons are 

invited to submit written comments 


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