Submission for OMB Review; Comment Request

DEPARTMENT OF LABOR

Office of the Secretary

Submission for OMB Review; Comment Request

July 29, 1998.

The Department of Labor (DOL) has submitted the following public

information collection requests (ICRs) to the Office of Management and

Budget (OMB) for review and approval in accordance with the Paperwork

Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. Chapter 35). A copy of

each individual ICR, with applicable supporting documentation, may be

obtained by calling the Department of Labor, Departmental Clearance

Officer, Todd R. Owen ({202} 219-5096 ext. 143) or by E-Mail to

Owen0T[email protected].

Comments should be sent to Office of Information and Regulatory

Affairs, Attn: OMB Desk Officer for BLS, DM, ESA, ETA, MSHA, OSHA,

PWBA, or VETS, Office of Management and Budget, Room 10235, Washington,

DC 20503 ({202} 395-7316), on or before September 3, 1998. The OMB 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 submission of responses.

Agency: Employment and Training Administration.

Title: Alien Claims Activity Report.

OMB Number: 1205-0268 (extension).

Agency Number: ETA 9016.

Frequency: quarterly.

Affected Public: State, Local or Tribal Government.

Number of Respondents: 53.

Total Responses: 212.

Estimated Time per Respondent: 1 hour.

Total Burden Hours: 212.

Total annualized capital/startup costs: 0.

Total annual costs (operating/maintaining systems or purchasing

services): 0.

Description: The ETA 9016 allows assessment of cost efficiency of

the Immigration and Naturalization Service verification system (SAVE)

and allows the determination of the impact of the Immigration Reform

and Control Act of the Unemployment Insurance system nationally.

Agency: Employment Standards Administration.

Title: Employer's First Report of Injury or Occupational Illness

(LS-202); Physician's Report on Impairment of Vision (LS-205);

Employer's Supplementary Report of Accident or Occupational Illness

(LS-210).

OMB Number: 1215-0031 (extension).

Agency Numbers: LS-202, LS-205, LS-210.

Frequency: On occasion.

Affected Public: Individuals or households; Business or other for-

profit; Not-for-profit institutions.

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

Average

time per Burden

Form Respondents response hours

(hours)

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

LS-202................................. 27,000 .25 6,750

LS-205................................. 90 .75 68

LS-210................................. 2,900 .25 725

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

Total Responses: 29,990.

Total Burden Hours: 7,543.

Total annualized capital/startup costs: 0.

Total annual costs (operating/maintaining systems or purchasing

services): $11,846.05.

Description: The Longshore and Harbor Worker's Compensation Act

provides benefits to workers injured in maritime employment on

navigable waters of the United States or in an adjoining area

customarily used by an employee in loading, unloading, repairing or

building a vessel. The LS-202, Employer's First Report of Injury or

Occupational Illness, is used by employers to report injuries that have

occurred under the Longshore Act and its related statutes. The LS-210,

Employer's Supplementary Report of Accident or Occupational Illness, is

used to report additional periods of lost time from work. The LS-205,

Physician's Report on Impairment of Vision, is a medical report based

on a comprehensive examination of visual impairment.

Agency: Employment Standards Administration.

Title: Medical Travel Fund Request.

OMB Number: 1215-0054 (extension).

Agency Number: CM-957.

Frequency: On occasion.

Affected Public: Individuals or households; Business or other for-

profit; Not-for-profit institutions.

Number of Respondents: 8,700.

Total Responses: 8,700.

Estimated Time per Respondent: 10 minutes.

Total Burden Hours: 1,450.

Total annualized capital/startup costs: 0.

Total annual costs (operating/maintaining systems or purchasing

services): $3,045.

Description: When a coal miner files an application for black lung

benefits under the Black Lung Benefits Act, the miner is scheduled for

medical determination testing. The Black Lung Trust fund is required to

pay for this determination testing and associated travel costs. The CM-

957 is used by the miner to record travel expenses incurred while

traveling to and from the testing facility.

Agency: Employment Standards Administration.

Title: Request for State or Federal Worker's Compensation

Information.

OMB Number: 1215-0060 (extension).

Agency Number: CM-905.

Frequency: On occasion.

Affected Public: Federal Government; State, Local or Tribal

Government.

Number of Respondents: 3,986.

Total Responses: 3,986.

Estimated Time per Respondent: 15 minutes.

Total Burden Hours: 996 hours.

Total annualized capital/startup costs: 0.

Total annual costs (operating/maintaining systems or purchasing

services): $1,395.00.

[[Page 41595]]

Description: The Federal Mine Safety and Health Act of 1977, as

amended, 30 U.S.C. 922(b) and 20 CFR 725.535, direct that the

Department of Labor Black Lung benefit payments to a beneficiary for

any month be reduced by any other payments of sate or federal benefits

for workers compensation due to black lung disease. This form collects

information regarding the status of any state or Federal workers'

compensation claim, including dates of payments, weekly or lump sum

amounts paid, and other fees or expenses paid out of this award, such

as attorney fees and related expenses associated with black lung

disease.

Agency: Employment Standards Administration.

Title: Notice of Law Enforcement Officer's Injury or Occupational

Disease (CA-721); Notice of Law Enforcement Officer's Death (CA-722).

OMB Number: 1215-0116 (extension).

Agency Number: CA-721 and CA-722.

Frequency: On occasion.

Affected Public: Individuals or households; Business or other for-

profit; State, Local or Tribal Government.

Number of Respondents: 63.

Total Responses: 63.

Estimated Time per Respondent: 60 minutes (CA-721); 90 minutes (CA-

722).

Total Burden Hours: 87.

Total annualized capital/startup costs: 0.

Total annual costs (operating/maintaining systems or purchasing

services): $30.45.

Description: These forms are used for filing claims for

compensation for injury and death to non-Federal law enforcement

officers under the provisions of 5 U.S.C. 8191 et seq. The forms

provide the basic information needed to process the claims made for

injury or death.

Agency: Employment Standards Administration.

Title: Maintenance of Receipts for Benefits paid by a coal mine

operator.

OMB Number: 1215-0124 (extension).

Agency Number: CM-200.

Frequency: On occasion.

Affected Public: Business or other for-profit; State, Local or

Tribal Government.

Number of Respondents: 150.

Total Responses: 150.

Total Burden Hours: 1 hour.

Total annualized capital/startup costs: 0.

Total annual costs (operating/maintaining systems or purchasing

services): 0.

Description: The Office of Workers' Compensation Program

administers the Black Lung Benefits Act. Under 20 CFR 725.531, self-

insured coal mine operators or insurance carriers must maintain

receipts for black lung benefit payments made for five years after the

date on which the receipt was executed. This requirement is designated

as CM-200, Maintenance of Receipts for Benefits Paid by a Coal Mine

Operator. There is no form or format for the receipts; a canceled check

will satisfy the requirement.

Agency: Employment Standards Administration.

Title: Rehabilitation Maintenance Certificate.

OMB Number: 1215-0161 (extension).

Agency Number: OWCP-17.

Frequency: Every four weeks.

Affected Public: Individuals or households; Businesses or other

for-profit; Not-for-profit institutions; State, Local or Tribal.

Number of Respondents: 1,300.

Total Responses: 15,600.

Estimated Time per Respondent: 10 minutes.

Total Burden Hours: 2,605.

Total annualized capital/startup costs: 0.

Total annual costs (operating/maintaining systems or purchasing

services): 0.

Description: The Office of Workers' Compensation Program

administers the Longshore and Harbor Workers' Compensation Act (LHWCA)

and the Federal Employees' Compensation act (FECA). The Acts provide

rehabilitation benefits to eligible injured workers. The Rehabilitation

Maintenance Certificate is used to request reimbursement for expenses

incurred as a result of an injured employee's participation in an

approved rehabilitation effort.

Agency: Mine Safety and Health Administration.

Title: Certificate of Training.

OMB Number: 1219-0070 (revision).

Frequency: Annually.

Affected Public: Business or other for-profit.

Number of Respondents: 13,763.

Total Responses: 633,098.

Estimated Time per Respondent: .08 minutes.

Total Burden Hours: 20,204.

Total annualized capital/startup costs: 0.

Total annual costs (operating/maintaining systems or purchasing

services): $814,491.

Description: Requires MSHA Form 5000-23, Certificate of Training,

and Optional MSHA Form 5000-23T, Certificate of Task Training, to be

used by mine operators to record mandatory training received by miners.

The forms provide the mine operator with a recordkeeping form, the

miner with a certificate of training, and MSHA with a monitoring tool

for determining compliance requirements.

Todd R. Owen,

Departmental Clearance Officer.

[FR Doc. 98-20796 Filed 8-3-98; 8:45 am]

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