Agency Information Collection Activities; Announcement of the Office of Management and Budget (OMB) Control Numbers in Accordance with the Paperwork Reduction Act

---
identifier: "/us/fr/2010-10493"
source: "fr"
legal_status: "authoritative_unofficial"
title: "Agency Information Collection Activities; Announcement of the Office of Management and Budget (OMB) Control Numbers in Accordance with the Paperwork Reduction Act"
title_number: 0
title_name: "Federal Register"
section_number: "2010-10493"
section_name: "Agency Information Collection Activities; Announcement of the Office of Management and Budget (OMB) Control Numbers in Accordance with the Paperwork Reduction Act"
positive_law: false
currency: "2010-05-05"
last_updated: "2010-05-05"
format_version: "1.1.0"
generator: "[email protected]"
agency: "Labor Department"
document_number: "2010-10493"
document_type: "notice"
publication_date: "2010-05-05"
agencies:
  - "Labor Department"
  - "Workers' Compensation Programs Office"
fr_citation: "75 FR 24744"
fr_volume: 75
fr_action: "Notice; Announcement of NEW OMB Control Numbers for OWCP."
---


#  Agency Information Collection Activities; Announcement of the Office of Management and Budget (OMB) Control Numbers in Accordance with the Paperwork Reduction Act

**AGENCY:**

Office of Workers' Compensation Programs (OWCP), Labor.

**ACTION:**

Notice; Announcement of NEW OMB Control Numbers for OWCP.

**SUMMARY:**

Pursuant to the Department's reorganization plan effective November 8, 2009, the Department of Labor's (DOL's) former Employment Standards Administration (ESA) (OMB Account Number 1215) was dissolved and its functions were assigned among its four former sub-agencies, of which OWCP was one, by Secretary's Order 9-2009 (74 FR 58836). Thereafter, OMB assigned new Control Numbers for OWCP's collections of information formerly inventoried under the dissolved ESA account.

**DATES:**

This notice is effective upon publication in the *Federal Register* .

**FOR FURTHER INFORMATION CONTACT:**

Vincent Alvarez, Agency Clearance Officer, Office of Workers' Compensation, U.S. Department of Labor, Room S-3524, 200 Constitution Avenue, NW., Washington, DC 20210, telephone: (202) 693-0372 (this is not a toll-free number) or e-mail: *[email protected].*

**SUPPLEMENTARY INFORMATION:**

In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520), OMB has assigned new Control Numbers to the collections of information formerly inventoried under the OMB account 1215. The new OMB Control Numbers and current OMB-assigned expiration dates are listed below, along with any applicable regulatory citations and/or Agency form numbers.

| Previous OMB control No. | New OMB control No. | CFR citation | Agency form No. | Current expiration date |
| --- | --- | --- | --- | --- |
| 1215-0022 | 1240-0043 | 20 CFR 702.234 | LS-206 | 10/31/2011 |
| 1215-0023 | 1240-0042 | 20 CFR 702.251 | LS-207 | 12/31/2011 |
| 1215-0024 | 1240-0041 | 20 CFR 702.236, 702.235 | LS-208 | 01/31/2012 |
| 1215-0027 | 1240-0040 | 20 CFR 702.121 | LS-265 | 02/28/2011 |
| 1215-0031 | 1240-0003 | 20 CFR 702.201, 702.202, 702.407 | LS-202, LS-210 | 12/31/2010 |
| 1215-0034 | 1240-0039 | 20 CFR 726.110 | OWCP-1 | 10/31/2011 |
| 1215-0052 | 1240-0038 | 20 CFR 725.304a, 725.404a | CM-911, CM-911A | 09/30/2011 |
| 1215-0054 | 1240-0037 | 20 CFR 10.315, 30.404, 725.406 and 725.701 | OWCP-957 | 08/31/2010 |
| 1215-0055 | 1240-0044 | 20 CFR 10.801, 30.701, 725.701, 725.704, 725.405 | OWCP-1500 | 11/30/2012 |
| 1215-0056 | 1240-0035 | 20 CFR 718.204 | CM-913 | 02/28/2011 |
| 1215-0057 | 1240-0034 | 20 CFR 725.405, 725.406, 725.407, 725.408 | CM-936 | 11/30/2012 |
| 1215-0058 | 1240-0033 | 20 CFR 725.408, 725.412 | CM-2970, CM2970A | 12/31/2010 |
| 1215-0059 | 1240-0048 | 20 CFR 726.206, 726.208, 726.213 | CM-921 (Extension request pending in OCIO) | 04/30/2010 |
| 1215-0060 | 1240-0032 | 20 CFR 725.535 | CM-905 | 09/30/2010 |
| 1215-0061 | 1240-0031 | 20 CFR 725.208 | CM-981 | 05/31/2010 |
| 1215-0064 | 1240-0030 | 20 CFR 725.621 | CM-908 | 06/30/2012 |
| 1215-0066 | 1240-0029 | 20 CFR 702.419 | LS-1 | 05/31/2011 |
| 1215-0067 | 1240-0045 | 20 CFR 10.518, 10.519, 702.506, 702.507 | OWCP-16 | 05/31/2011 |
| 1215-0069 | 1240-0027 | 20 CFR 410.221, CFR 725.304 | CM-912 | 08/31/2010 |
| 1215-0073 | 1240-0026 | 20 CFR 702.121 | LS-266 | 01/31/2011 |
| 1215-0078 | 1240-0049 | 20 CFR 10.700, 10.702, 702.132 | CA-143 | 12/31/2012 |
| 1215-0084 | 1240-0028 | 20 CFR 725.513 | CM-929, CM-929P | 06/30/2011 |
| 1215-0085 | 1240-0036 | 20 CFR 702.317 | LS-18 | 03/31/2011 |
| 1215-0090 | 1240-0023 | 20 CFR 718.102, 718.103, 718.104, 718.105 | CM-933, CM-988, CM-2907, CM-1159, CM-933B | 08/31/2011 |
| 1215-0103 | 1240-0046 | 20 CFR 10.102, 10.211, 10.300, 10.314, 10.331, 10.404, 10.506 | CA-17, CA-16, CA-20, OWCP-5c, OWCP-5b, OWCP-5A, CA-1332, CA-1331, CA-7 | 09/30/2011 |
| 1215-0105 | 1240-0047 | 20 CFR 10.525 | CA-1027 | 12/31/2012 |
| 1215-0112 | 1240-0025 | 33 USC 910 | LS-426 | 06/30/2012 |
| 1215-0113 | 1240-0024 | 20 CFR 725.701, 725.706, 725.707 | CM-893 | 10/31/2011 |
| 1215-0116 | 1240-0022 | 20 CFR 10.735 | CA-721,  CA-722 | 08/31/2010 |
| 1215-0137 | 1240-0021 | 20 CFR 10.801, 30.701, 725.704, 725.705 | OWCP-1168 | 11/30/2012 |
| 1215-0144 | 1240-0051 | 20 CFR 10.430-10.441, 725.544(c), 30.510-520 | OWCP-20 | 11/30/2012 |
| 1215-0151 | 1240-0016 | 20 CFR 10.528 | CA-1032 | 02/28/2011 |
| 1215-0154 | 1240-0015 | 20 CFR 10.126 | CA-12 | 05/31/2011 |
| 1215-0155 | 1240-0013 | 20 CFR 10.7, 10.105, 10.410, 10.413, 10.417, 10.535, 10.537 | CA-5, CA-5B, CA-1031, CA-1074 | 05/31/2010 |
| 1215-0160 | 1240-0014 | 20 CFR 702.111, 702.162, 702.174, 702.175, 702.201, 702.202, 702.221, 702.321, 702.242, 702.285, 703.310 | LS-204, LS-267, LS-262, LS-271, LS-274, LS-203, LS-513, LS-200, LS-201 | 06/30/2012 |
| 1215-0161 | 1240-0012 | 5 USC § 8111(b) (FECA) and 33 USC § 908(g) (LHWCA) | OWCP-17 | 06/30/2012 |
| 1215-0166 | 1240-0010 | 20 CFR 725.505-513 | CM-910 | 03/31/2012 |
| 1215-0167 | 1240-0009 | 20 CFR 10.104 | CA-2a | 05/31/2011 |
| 1215-0171 | 1240-0011 | 20 CFR 725.365, 725.366 | CM-972 | 12/31/2010 |
| 1215-0173 | 1240-0020 | 20 CFR 725.510, 725.511, 725.512, 725.513 | CM-623, CM623S, CM-787 | 09/30/2011 |
| 1215-0176 | 1240-0019 | 20 CFR 10.801, 30.701, 725.405, 725.406, 725.701, 725.704 | OWCP-04 | 11/30/2012 |
| 1215-0178 | 1240-0018 | 5 U.S.C. 8104 | CA-2231 | 06/30/2010 |
| 1215-0182 | 1240-0008 | 5 USC §§ 8104(a) and 8111(b) (FECA) and 33 USC §§ 908(g) and 939(c) | OWCP-44 | 07/31/2011 |
| 1215-0193 | 1240-0007 | 20 CFR 10.802, 30.702, 725.701, 725.705 | OWCP-915 | 12/31/2012 |
| 1215-0194 | 1240-0050 | 20 CFR 10.801, 30.701, 725.701, 725.705 | Instruction only (Pharmacy Billing Request ) | 12/31/2012 |
| 1215-0197 | 1240-0002 | 20 CFR 30.100, 30.101, 30.102, 30.103, 30.111, 30.113, 30.114, 30.206, 30.207, 30.212, 30.213, 30.214, 30.221, 30.222, 30.231, 30.415, 30.416, 30.417, 30.505, 30.620, 30.806 | EE-1, EE-2, EE-3, EE-4, EE-7, EE-8, EE-9, EE-10, EE-20 | 08/31/2010 |
| 1215-0200 | 1240-0001 | 20 CFR 10.707, 10.710 | CA-1108, CA-1122 | 06/30/2012 |
| 1215-0202 | 1240-0006 | 20 CFR 61.101, 61.104 | CA-278 | 08/31/2010 |
| 1215-0204 | 1240-0005 | 20 CFR 703.203, 703.204, 703.205, 703.209, 702.210, 703.212, 703.303, 703.304 | LS-275-IC, LS-275-SI, LS-276 | 09/30/2010 |
| 1215-0206 | 1240-0017 | 20 CFR 10.900 | CA-40, CA-41, CA-42 | 06/31/2010 |
| 1215-0207 | 1240-0004 | 20 CFR 703.116 | LS-570 | 12/31/2012 |

The Department notes that notwithstanding any other provision of law, individuals are not required to respond to a collection of information or revision thereof unless approved by OMB under the PRA and it displays a currently valid OMB Control Number. 35 U.S.C. 3506(c)(1)(B)(iii)(V) and 5 CFR 1320.5(b).

**Authority and Signature**

The authority for this notice is the Paperwork Reduction Act of 1995 (44 U.S.C. 3506 *et seq.* ) and Secretary of Labor's Order No. 9-2009 (74 FR 58836).

Signed at Washington, DC, this 29th day of April, 2010.

Vincent Alvarez,

Agency Clearance Officer, Office of Workers' Compensation Programs, US Department of Labor.