Agency Information Collection Activities; Submission for OMB Review; Comment Request; Energy Employees Occupational Illness Compensation Program Act Forms, 64539-64540 [2013-25392]

Download as PDF Federal Register / Vol. 78, No. 209 / Tuesday, October 29, 2013 / Notices 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. Authority: 44 U.S.C. 3507(a)(1)(D). BILLING CODE 4510–43–P DEPARTMENT OF LABOR mstockstill on DSK4VPTVN1PROD with NOTICES Office of the Secretary Agency Information Collection Activities; Submission for OMB Review; Comment Request; Energy Employees Occupational Illness Compensation Program Act Forms Notice. The Department of Labor (DOL) is submitting the Office of Workers’ Compensation Programs (OWCP) sponsored information collection request (ICR) revision titled, SUMMARY: VerDate Mar<15>2010 18:15 Oct 28, 2013 Jkt 232001 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 SUPPLEMENTARY INFORMATION: [FR Doc. 2013–25393 Filed 10–28–13; 8:45 am] ACTION: ‘‘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. PO 00000 Frm 00073 Fmt 4703 Sfmt 4703 64539 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 E:\FR\FM\29OCN1.SGM 29OCN1 mstockstill on DSK4VPTVN1PROD with NOTICES 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.) VerDate Mar<15>2010 18:15 Oct 28, 2013 Jkt 232001 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 PO 00000 Frm 00074 Fmt 4703 Sfmt 9990 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 E:\FR\FM\29OCN1.SGM 29OCN1

Agencies

[Federal Register Volume 78, Number 209 (Tuesday, October 29, 2013)]
[Notices]
[Pages 64539-64540]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-25392]


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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 Labor-OASAM, 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

[[Page 64540]]

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