# Agency Recordkeeping/Reporting Requirements Under Review by the Office of Management and Budget (OMB) > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/fr%3A95-15213 ## Record - **Collection:** Federal Register - **Document type:** Notice - **Published:** June 21, 1995 - **Citation:** 60 FR 32341 ## Text DEPARTMENT OF LABOR Office of the Secretary Agency Recordkeeping/Reporting Requirements Under Review by the Office of Management and Budget (OMB) June 15, 1995. The Department of Labor has submitted the following public information collection requests (ICRs) to the Office of Management and Budget (OMB) for review and clearance under the Paperwork Reduction Act (44 U.S.C. Chapter 35) of 1980, as amended (P.L. 96-511). Copies may be obtained by calling the Department of Labor Acting Departmental Clearance Officer, Theresa M. O'Malley ({202} 219-5095). Comments and questions about the ICRs listed below should be directed to Ms. O'Malley, Office of Information Resources Management Policy, U.S. Department of Labor, 200 Constitution Avenue, NW., Room N-1301, Washington, DC 20210. Comments should also be sent to the Office of Information and Regulatory Affairs, Attn: OMB Desk Officer for (BLS/DM/ ESA/ETA/OAW/MSHA/OSHA/PWBA/VETS), Office of Management and Budget, Room 10325, Washington, DC 20503 ({202}) 395-7316). Individuals who use a telecommunications device for the deaf (TTY/ TDD) may call {202} 219-4720 between 1:00 p.m. and 4:00 p.m. Eastern time, Monday through Friday. Type of Review: Revision Agency: Bureau of Labor Statistics Title: National Longitudinal Survey of Youth 79 OMB Number: 1220-0109 Agency number: NORC-4531 Frequency: Biennially Affected Public: Individuals or households Number of Respondents: 8,850 Estimated Time per Respondent: 100 minutes Total Burden Hours: 14,750 Description: The information provided in this survey will be used by the Department of Labor and other government agencies to help understand and explain the employment, unemployment, and related problems faced by young men and women in this age group. Type of Review: Revision Agency: Employment Standards Administration Title: Application for a Farm Labor Contractor Employee Certificate of Registration OMB Number: 1215-0037 Agency number: WH-512 MIS Frequency: On occasion Affected Public: Individuals or households; Business or other for- profit; Farms Number of Respondents: 2,700 Estimated Time per Respondent: 30 minutes Total Burden Hours: 1,350 Description: The Migrant Seasonal Agricultural Worker Protection Act provides that no individual may perform farm labor contracting activities without a certificate of registration. Form WH-512 MIS is an application form which provides the Department of Labor with the information necessary to issue a certificate specifying the farm labor contracting activities authorized. Type of Review: Extension Agency: Employment Standards Administration Title: Medical Travel Refund Request OMB Number: 1215-0054 Agency Number: CM-957 Frequency: On occasion Affected Public: Individuals or households; Business or other for- profit Number of Respondents: 12,000 Estimated Time Per Respondent: 10 minutes Total Burden Hours: 2,000 Description: This form is used by coal miners requesting reimbursement for out-of-pocket expenses incurred when traveling to medical providers for black lung diagnostic testing or treatment of their black lung disease. [[Page 32342]] Type of Review: Extension Agency: Employment Standards Administration Title: Operator Controversion--CM-970; Operator Response--CM-970a OMB Number: 1215-0058 Agency Number: CM-970; CM-970a Frequency: On occasion Affected Public: Business or other for-profit Number of Respondents: 3,500 Estimated Time Per Respondent: 15 minutes Total Burden Hours: 1,750 Description: The CM-970 and the CM-970a are used by most coal mine operators to controvert an initial finding or potential liability for payment of black lung benefits under the Act. Type of Review: Extension Agency: Employment Standards Administration Title: Request for State or Federal Workers' Compensation Information OMB Number: 1215-0060 Agency Number: CM-905 Frequency: On occasion Affected Public: Federal Government; State, Local or Tribal Government Number of Respondents: 4,440 Estimated Time Per Respondent: 15 minutes Total Burden Hours: 1,100 Description: The Federal Mine Safety and Health Act of 1977, as amended, 30 U.S.C. 922 and 20 CFR 725.535 direct that Department of Labor benefit payments to a beneficiary for any month be reduced by any other payments of State of Federal benefits for workers' compensation due to pneumoconiosis. To ensure compliance with this mandate, the Division of Coal Mine Workers Compensation (DCMWC) must collect information regarding the status of any State or Federal workers' compensation claim, including date of payments, weekly or lump sum amounts paid, and other fees or expenses paid out of this award. The information is used by the DCMWC in determining the amounts of black lung benefits paid to beneficiaries. Type of Review: Extension Agency: Employment Standards Administration Title: Survivor's Notification of Beneficiary's Death OMB Number: 1215-0087 Agency Number: CM-1089 Frequency: On occasion Affected Public: Individuals or households Number of Respondents: 2,100 Estimated Time Per Respondent: 8 minutes Total Burden Hours: 280 Description: The CM-1089 is used to gather information from a beneficiary's survivor to ensure that benefits due on behalf of a deceased miner are accurate for continuation of benefits. Type of Review: Extension Agency: Employment Standards Administration Title: Survivor's Notification of Beneficiary's Death OMB Number: 1215-0116 Agency Number: CA-721, CA-722 Frequency: On occasion Affected Public: Individuals or households; Business or other for- profit; State, local or Tribal Government ------------------------------------------------------------------------ Estimated time per Form Respondents respondent minutes ------------------------------------------------------------------------ CA-721......................................... 16 60 CA-722......................................... 47 90 ------------------------------------------------------------------------ Total Burden Hours: 87 Description: These forms are used for filing claims for compensation for injury and death to non-Federal law enforcement officers under the provisions of U.S.C. 8191, etc. seq. The forms provide the basic information needed to process the claims made for injury or death. Type of Review: Extension Agency: Employment Standards Administration Title: Waiver of Child Labor Provisions for Agricultural employment of 10 and 11 Year Old Minor in Hand Harvesting of Short Season Crops OMB Number: 1215-0120 Frequency: On occasion Affected Public: Individuals or households; Farms Number of Respondents: 1 Estimated Time Per Respondent: 4 hours Total Burden Hours: 4 Description: Agricultural employers must supply certain information to the Department of Labor when applying for a waiver of the child labor provisions to employ 10 and 11 year old minors in hand harvesting of short season crops. Employers granted waivers are required to maintain certain records. Type of Review: Extension Agency: Employment Standards Administration Title: Maintenance of Receipt for Benefits Paid by a Coal Mine Operator OMB Number: 1215-0124 Agency: CM-200 Frequency: Recordkeeping Affected Public: Business or other for-profit Number of Respondents: 150 Estimated Time Per Respondent: 1 hour Total Burden Hours: 150 Description: Insurance carriers and self-insured coal mine operators who make benefit payments to black lung beneficiaries are required to maintain receipts for black lung benefit payments for five years after the date on which the receipt was executive in order to verify payment of black lung benefits. Type of Review: Revision Agency: Employment Standards Administration Title: Labor Standards for Federal Service Contracts OMB Number: 1215-0150 Frequency: On occasion Affected Public: Business or other for-profit; Federal Government Number of Respondents: 55,567 ------------------------------------------------------------------------ Estimated time Type Respondents per respondent ------------------------------------------------------------------------ Vacation benefit seniority list.......... 53,267 1 hour. Conformance record....................... 300 30 minutes. Collective bargaining agreements......... 2,000 5 minutes. ------------------------------------------------------------------------ Total Burden Hours: 53,584 Description: This information collection is in accordance with the provisions of 29 CFR part 4 for recordkeeping and incidental reporting requirements in Service Contract Act Regulations applicable to employers performing on service contracts with the Federal government. Type of Review: Extension Agency: Employment Standards Administration Title: Rehabilitation Maintenance Certificate OMB Number: 1215-0161 Agency number: OWCP 17 Frequency: On occasion Affected Public: Individuals or households; Business or other for- profit; Not-for-profit institutions Number of Respondents: 1,300 Estimated Time per Respondent: 10 minutes Total Burden Hours: 15,600 Description: The Office of Workers Compensation Program (OWCP 17) serves as a bill submitted by the injured worker to OWCP requesting reimbursement of expenses incurred due to participation in an approved rehabilitation effort for the preceding four week period or fraction thereof. [[Page 32343]] Type of Review: Extension Agency: Employment Standards Administration Title: Application for Approval of a Representative's Fee in a Black Lung Proceeding Conducted by the Department of Labor OMB Number: 12515-0171 Agency number: CM-972 Frequency: On occasion Affected Public: Business or other for-profit Number of Respondents: 1,600 Estimated Time per Respondent: 42 minutes Total Burden Hours: 1,120 Description: Specific requirements are set forth in 20 CFR 725.365 and 725.366 for the items of information that must be included on representative fee applications in order for the representative to be paid. The CM-972 is designed to collect this information. Type of Review: Reinstatement Agency: Employment and Training Administration Title: Internal Fraud Activities OMB Number: 1215-0187 Agency number: ETA 9000 Frequency: Annual Affected Public: Federal Government; State, Local or Tribal Government Number of Respondents: 53 Estimated Time per Respondent: 3 hours Total Burden Hours: 159 Description: Form ETA 9000 is the State Employment Security Agency's (SESA) Employment and Training Administration's (ETA) sole data collection instrument to identifying continuing activity involving internal fraud and assessing fraud prevention effectiveness. Resulting analysis will be communicated to SESAs to enhance management efforts in controlling false representation and fraud. Negative trends could result in ETA requesting Office of the Inspector General audits. Type of Review: Revision Agency: Employment and Training Administration Title: Attestation by Employers Using Alien Crewmembers for Longshore Activities in U.S. Ports OMB Number: 1205-0309 Agency number: ETA 9033 Frequency: As needed Affected Public: Individuals or households; Business or other for- profit; Not-for-profit institutions; Federal Government; State, Local or Tribal Government Number of Respondents: 500 Estimated Time per Respondent: 4 hours Total Burden Hours: 2,000 Description: The information provided on this form by employers seeking to use alien crewmembers to perform longshore work at U.S. ports will permit the Department of Labor to meet Federal responsibilities for program administration, management and oversight. Type of Review: Extension Agency: Mine Safety Health Administration Title: Training Plan Regulations (30 CFR 48.3 and 48.23) OMB Number: 1219-0009 Frequency: On occasion Affected Public: Business or other for-profit Number of Respondents: 1,300 Estimated Time per Respondent: 8 hours Total Burden Hours: 10,400 Description: Requires mine operators to have a Mine Safety and Health Administration approved plan containing programs for training new miners, training newly-employed experienced miners, training miners for new tasks, annual refresher training, and hazard training. Type of Review: Extension Agency: Departmental Management, Office of the Solicitor Title: Equal Access to Justice Act OMB Number: 1225-0013 Frequency: On occasion Affected Public: Individuals or households; Business or other for- profit; Not-for-profit institutions; Federal Government; State, Local or Tribal Government Number of Respondents: 10 Estimated Time per Respondent: 5 hours Total Burden Hours: 50 Description: The Equal Access to Justice Act provides for payment of fees and expenses to eligible parties who have prevailed against the Department of Labor in certain administrative proceedings. In order to obtain an aware, the statute and regulations require the filing of an application. Theresa M. O'Malley, Acting Departmental Clearance Officer. [FR Doc. 95-15213 Filed 6-20-95; 8:45 am BILLING CODE 4510-27-M --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A95-15213. Public record. Not legal advice.