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
<![CDATA[
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 https://
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]
-----------------------------------------------------------------------
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 https://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
