Agency Information Collection Activities; Comment Request; Representative Payee Report, Representative Payee Report (Short Form), and Physician's/Medical Officer's Statement, 86582-86583 [2020-28897]

Download as PDF 86582 Federal Register / Vol. 85, No. 250 / Wednesday, December 30, 2020 / Notices December 19, 2020. The state will remain in an ‘‘off’’ period for a minimum of 13 weeks. • Based on the data submitted by Vermont for the week ending November 28, 2020, Vermont’s 13-week IUR was 4.90 percent, falling below the 5.0 percent IUR threshold necessary to remain ‘‘on’’ EB. Therefore, the EB period for Vermont ends on December 19, 2020. The state will remain in an ‘‘off’’ period for a minimum of 13 weeks. The trigger notice covering state eligibility for the EB program can be found at: https://ows.doleta.gov/ unemploy/claims_arch.as Information for Claimants The duration of benefits payable in the EB program, and the terms and conditions on which they are payable, are governed by the Federal-State Extended Unemployment Compensation Act of 1970, as amended, and the operating instructions issued to the states by the U.S. Department of Labor. In the case of a state beginning an EB period, the State Workforce Agency will furnish a written notice of potential entitlement to each individual who has exhausted all rights to regular benefits and is potentially eligible for EB (20 CFR 615.13(c)(1)). Persons who believe they may be entitled to EB, or who wish to inquire about their rights under the program, should contact their State Workforce Agency. Signed in Washington, DC. John Pallasch, Assistant Secretary for Employment and Training. [FR Doc. 2020–28794 Filed 12–29–20; 8:45 am] BILLING CODE 4510–FW–P DEPARTMENT OF LABOR Office of Workers’ Compensation Programs Agency Information Collection Activities; Comment Request; Representative Payee Report, Representative Payee Report (Short Form), and Physician’s/Medical Officer’s Statement Notice of availability; request for comments. ACTION: The Department of Labor (DOL) is soliciting comments concerning a proposed extension of the information collection request (ICR) titled, ‘‘Representative Payee Report, Representative Payee Report (Short Form), and Physician’s/Medical SUMMARY: VerDate Sep<11>2014 17:47 Dec 29, 2020 Jkt 253001 Officer’s Statement.’’ This comment request is part of continuing Departmental efforts to reduce paperwork and respondent burden in accordance with the Paperwork Reduction Act of 1995 (PRA). DATES: Consideration will be given to all written comments received by March 1, 2021. 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 by contacting Anjanette Suggs by telephone at (202) 354–9660 (this is not a toll-free number) or by email at suggs.anjanette@dol.gov. Submit written comments about, or requests for a copy of, this ICR by mail or courier to the U.S. Department of Labor, Office of Workers’ Compensation Program, Division of Coal Mine Workers’ Compensation, Room N1301, 200 Constitution Avenue NW, Washington, DC 20210; by email: suggs.anjanette@dol.gov. FOR FURTHER INFORMATION CONTACT: Contact Anjanette Suggs by telephone at (202) 354–9660 (this is not a toll-free number) or by email at suggs.anjanette@ dol.gov. SUPPLEMENTARY INFORMATION: The DOL, as part of continuing efforts to reduce paperwork and respondent burden, conducts a pre-clearance consultation program to provide the general public and Federal agencies an opportunity to comment on proposed and/or continuing collections of information before submitting them to the OMB for final approval. This program helps to ensure 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 can be properly assessed. Benefits due to a DOL Black Lung beneficiary are 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 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. The Black Lung Benefits Act, 30 U.S.C. 922, authorizes this information collection. PO 00000 Frm 00054 Fmt 4703 Sfmt 4703 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. Interested parties are encouraged to provide comments to the contact shown in the ADDRESSES section. Comments must be written to receive consideration, and they will be summarized and included in the request for OMB approval of the final ICR. In order to help ensure appropriate consideration, comments should mention 1240–0020. Submitted comments will also be a matter of public record for this ICR and posted on the internet, without redaction. The DOL encourages commenters not to include personally identifiable information, confidential business data, or other sensitive statements/information in any comments. The DOL 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. Type of Review: Extension. Title of Collection: Representative Payee Report, Representative Payee Report (Short Form), and Physician’s/ Medical Officer’s Statement. Form: Representative Payee Report (CM–623), Representative Payee Report (Short Form) (CM–623S) and E:\FR\FM\30DEN1.SGM 30DEN1 Federal Register / Vol. 85, No. 250 / Wednesday, December 30, 2020 / Notices Physician’s/Medical Officer’s Statement (CM–787). OMB Control Number: 1240–0020. Affected Public: Individuals or Households. Estimated Number of Respondents: 1,325. Frequency: Annual. Total Estimated Annual Responses: 1,325. Estimated Average Time per Response: Varies. Estimated Total Annual Burden Hours: 679 hours. Total Estimated Annual Other Cost Burden: $0. Authority: 44 U.S.C. 3506(c)(2)(A). Anjanette Suggs, Agency Clearance Officer. [FR Doc. 2020–28897 Filed 12–29–20; 8:45 am] BILLING CODE 4510–CK–P OFFICE OF PERSONNEL MANAGEMENT Submission for Review: Application for Refund of Retirement Deductions, SF 3106 and Current/Former Spouse(s) Notification of Application for Refund of Retirement Deductions Under FERS, SF 3106A Office of Personnel Management. ACTION: 60-Day notice and request for comments. AGENCY: Retirement Services, Office of Personnel Management (OPM) offers the general public and other federal agencies the opportunity to comment on a revised information collection request (ICR), Application for Refund of Retirement Deductions, Federal Employees Retirement System, SF 3106 and Current/Former Spouse’s Notification of Application for Refund of Retirement Deductions under FERS, SF 3106A. DATES: Comments are encouraged and will be accepted until March 1, 2021. ADDRESSES: You may submit comments, identified by docket number and/or Regulatory Information Number (RIN) and title, by the following method: —Federal Rulemaking Portal:https:// www.regulations.gov. Follow the instructions for submitting comments. All submissions received must include the agency name and docket number or RIN for this document. The general policy for comments and other submissions from members of the public is to make these submissions available for public viewing at https:// www.regulations.gov as they are received without change, including any SUMMARY: VerDate Sep<11>2014 17:47 Dec 29, 2020 Jkt 253001 personal identifiers or contact information. A copy of this ICR with applicable supporting documentation, may be obtained by contacting the Retirement Services Publications Team, Office of Personnel Management, 1900 E Street NW, Room 3316–L, Washington, DC 20415, Attention: Cyrus S. Benson, or sent via electronic mail to Cyrus.Benson@opm.gov or faxed to (202) 606–0910 or via telephone at (202) 606–4808. SUPPLEMENTARY INFORMATION: As required by the Paperwork Reduction Act of 1995 (Pub. L. 104–13, 44 U.S.C. chapter 35) as amended by the ClingerCohen Act (Pub. L. 104–106), OPM is soliciting comments for this collection (OMB No. 3206–0121). The Office of Management and Budget is particularly interested in comments that: 1. Evaluate whether the proposed collection of information is necessary for the proper performance of functions of the agency, including whether the information will have practical utility; 2. 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; 3. Enhance the quality, utility, and clarity of the information to be collected; and 4. 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. Standard Form 3106, Application for Refund of Retirement Deductions under FERS is used by former Federal employees under FERS, to apply for a refund of retirement deductions withheld during Federal employment, plus any interest provided by law. Standard Form 3106A, Current/Former Spouse(s) Notification of Application for Refund of Retirement Deductions under FERS, is used by refund applicants to notify their current/former spouse(s) that they are applying for a refund of retirement deductions, which is required by law. FOR FURTHER INFORMATION CONTACT: Analysis Agency: Retirement Operations, Retirement Services, Office of Personnel Management. Title: Application for Refund of Retirement Deductions (FERS) and Current/Former Spouse’s Notification of PO 00000 Frm 00055 Fmt 4703 Sfmt 4703 86583 Application for Refund of Retirement Deductions under FERS. OMB Number: 3206–0170. Frequency: On occasion. Affected Public: Individuals or Households. Number of Respondents: SF 3106 = 8,000; SF 3106A = 6,400. Estimated Time per Respondent: SF 3106 = 30 minutes; SF 3106A = 5 minutes. Total Burden Hours: 4,533. Office of Personnel Management. Alexys Stanley, Regulatory Affairs Analyst. [FR Doc. 2020–28900 Filed 12–29–20; 8:45 am] BILLING CODE 6325–38–P OFFICE OF PERSONNEL MANAGEMENT Submission for Review: 3206–0121, Application for Deferred Retirement (for Persons Separated on or After October 1, 1956), OPM 1496A Office of Personnel Management. ACTION: 60-Day notice and request for comments. AGENCY: Retirement Services, Office of Personnel Management (OPM) offers the general public and other federal agencies the opportunity to comment on a revised information collection request (ICR), Application for Deferred Retirement (for Persons Separated on or after October 1, 1956), OPM 1496A. DATES: Comments are encouraged and will be accepted until March 1, 2021. ADDRESSES: You may submit comments, identified by docket number and/or Regulatory Information Number (RIN) and title, by the following method: —Federal Rulemaking Portal: https:// www.regulations.gov. Follow the instructions for submitting comments. All submissions received must include the agency name and docket number or RIN for this document. The general policy for comments and other submissions from members of the public is to make these submissions available for public viewing at https:// www.regulations.gov as they are received without change, including any personal identifiers or contact information. SUMMARY: A copy of this ICR with applicable supporting documentation, may be obtained by contacting the Retirement Services Publications Team, Office of Personnel Management, 1900 E Street NW, Room 3316–L, Washington, DC 20415, Attention: Cyrus S. Benson, or FOR FURTHER INFORMATION CONTACT: E:\FR\FM\30DEN1.SGM 30DEN1

Agencies

[Federal Register Volume 85, Number 250 (Wednesday, December 30, 2020)]
[Notices]
[Pages 86582-86583]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-28897]


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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Agency Information Collection Activities; Comment Request; 
Representative Payee Report, Representative Payee Report (Short Form), 
and Physician's/Medical Officer's Statement

ACTION: Notice of availability; request for comments.

-----------------------------------------------------------------------

SUMMARY: The Department of Labor (DOL) is soliciting comments 
concerning a proposed extension of the information collection request 
(ICR) titled, ``Representative Payee Report, Representative Payee 
Report (Short Form), and Physician's/Medical Officer's Statement.'' 
This comment request is part of continuing Departmental efforts to 
reduce paperwork and respondent burden in accordance with the Paperwork 
Reduction Act of 1995 (PRA).

DATES: Consideration will be given to all written comments received by 
March 1, 2021.

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 by 
contacting Anjanette Suggs by telephone at (202) 354-9660 (this is not 
a toll-free number) or by email at [email protected].
    Submit written comments about, or requests for a copy of, this ICR 
by mail or courier to the U.S. Department of Labor, Office of Workers' 
Compensation Program, Division of Coal Mine Workers' Compensation, Room 
N1301, 200 Constitution Avenue NW, Washington, DC 20210; by email: 
[email protected].

FOR FURTHER INFORMATION CONTACT: Contact Anjanette Suggs by telephone 
at (202) 354-9660 (this is not a toll-free number) or by email at 
[email protected].

SUPPLEMENTARY INFORMATION: The DOL, as part of continuing efforts to 
reduce paperwork and respondent burden, conducts a pre-clearance 
consultation program to provide the general public and Federal agencies 
an opportunity to comment on proposed and/or continuing collections of 
information before submitting them to the OMB for final approval. This 
program helps to ensure 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 can be properly assessed.
    Benefits due to a DOL Black Lung beneficiary are 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 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. The 
Black Lung Benefits Act, 30 U.S.C. 922, authorizes this information 
collection.
    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.
    Interested parties are encouraged to provide comments to the 
contact shown in the ADDRESSES section. Comments must be written to 
receive consideration, and they will be summarized and included in the 
request for OMB approval of the final ICR. In order to help ensure 
appropriate consideration, comments should mention 1240-0020.
    Submitted comments will also be a matter of public record for this 
ICR and posted on the internet, without redaction. The DOL encourages 
commenters not to include personally identifiable information, 
confidential business data, or other sensitive statements/information 
in any comments.
    The DOL 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.
    Type of Review: Extension.
    Title of Collection: Representative Payee Report, Representative 
Payee Report (Short Form), and Physician's/Medical Officer's Statement.
    Form: Representative Payee Report (CM-623), Representative Payee 
Report (Short Form) (CM-623S) and

[[Page 86583]]

Physician's/Medical Officer's Statement (CM-787).
    OMB Control Number: 1240-0020.
    Affected Public: Individuals or Households.
    Estimated Number of Respondents: 1,325.
    Frequency: Annual.
    Total Estimated Annual Responses: 1,325.
    Estimated Average Time per Response: Varies.
    Estimated Total Annual Burden Hours: 679 hours.
    Total Estimated Annual Other Cost Burden: $0.

    Authority:  44 U.S.C. 3506(c)(2)(A).

Anjanette Suggs,
Agency Clearance Officer.
[FR Doc. 2020-28897 Filed 12-29-20; 8:45 am]
BILLING CODE 4510-CK-P

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