# Agency Information Collection Activities; Comment Request; Claim for Compensation by Dependents Information Reports
**AGENCY:**
Office of Workers' Compensation Programs, Division of Federal Employees', Longshore and Harbor Workers' Compensation—DFELHWC-FECA
**ACTION:**
Notice.
**SUMMARY:**
The Department of Labor (DOL) is soliciting comments concerning a proposed extension for the authority to conduct the information collection request (ICR) titled, “Claim for Compensation by Dependents Information Reports.” This 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 April 3, 2023.
**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 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 Programs, Room S3323, 200 Constitution Avenue NW, Washington, DC 20210; by email: *[email protected].*
**FOR FURTHER INFORMATION CONTACT:**
Contact Anjanette Suggs by telephone at 202-354-9660 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.
*Background:* The forms included in this package are forms used by Federal employees and their dependents to claim benefits, to prove continued eligibility for benefits, to show entitlement to remaining compensation payments of a deceased employee and to show dependency under the Federal Employees' Compensation Act. There are six items in this information collection request. The information collected by Forms CA-5 is used by dependents for claiming compensation for the work-related death of a Federal employee and Form CA-5b is used by other survivors. Form Letter CA-1031 is used in disability cases and provides information to determine whether a claimant is supporting a dependent and is entitled to additional compensation. Form Letter CA-1074 is a follow up to CA-5b to request clarification of any information that is unclear and incomplete in the CA-5b. The Form Letter “Compensation Due at Death” is used to request information necessary to distribute compensation due when an employee dies who was receiving or who was entitled to compensation at the time of death for either disability benefits or a scheduled award. The Form Letter “Student Dependency” is used to obtain information regarding the student status of a dependent. When a child reaches 18 years of age, they are no longer considered an eligible dependent unless they are a full time student or incapable of self-support. This information collection is currently approved for use through July 31, 2023.
This information collection is authorized by 5 CFR 1320.3(c)(3) and 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 the OMB under the PRA approves it 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. Written comments will receive consideration, and summarized and included in the request for OMB approval of the final ICR. In order to help ensure appropriate consideration, comments should mention 1240-0013.
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-Office of Workers' Compensation Programs.
*Type of Review:* Extension.
*Title of Collection:* Claim for Compensation by Dependents Information Reports.
*Forms:* CA-5, CA-5b; Form Letters (CA-1031, CA-1074, Compensation Due at Death, and Student Dependency).
*OMB Control Number:* 1240-0013.
*Affected Public:* Individuals or Households.
*Number of Respondents:* 1,241.
*Frequency:* On occasion.
*Number of Responses:* 1,241.
*Annual Burden Hours:* 1,063.
*Annual Respondent or Recordkeeper Cost:* $556.00.
*Authority:* 44 U.S.C. 3506(c)(2)(A).
Anjanette Suggs,
Agency Clearance Officer.