Skip to Content


Agency Information Collection Activities; Submission for OMB Review; Comment Request; Request To Be Selected as Payee

Document Details

Information about this document as published in the Federal Register.

Published Document

This document has been published in the Federal Register. Use the PDF linked in the document sidebar for the official electronic format.

Start Preamble




The Department of Labor (DOL) is submitting the Office of Workers' Compensation Programs (OWCP) sponsored information collection request (ICR) revision titled, “Request To Be Selected as Payee,” Form CM-910, to the Office of Management and Budget (OMB) for review and approval for use in accordance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C. 3501 et seq.).


Submit comments on or before April 30, 2012.


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 from the Web site,​public/​do/​PRAMain, on the day following publication of this notice or by contacting Michel Smyth by telephone at 202-693-4129 (this is not a toll-free number) or sending an email to

Submit comments about this request to the Office of Information and Regulatory Affairs, Attn: OMB Desk Officer for DOL-OWCP, Office of Management and Budget, Room 10235, Washington, DC 20503, Telephone: 202-395-6929/Fax: 202-395-6881 (these are not toll-free numbers), email:

Start Further Info


Contact Michel Smyth by telephone at 202-693-4129 (this is not a toll-free number) or by email at

End Further Info End Preamble Start Supplemental Information


Benefits are payable by the DOL to miners who are totally disabled due to pneumoconiosis and to certain survivors of a miner under the Federal Mine Safety and Health Act of 1977, as amended (30 U.S.C. 901 et seq.). If a beneficiary is incapable of handling his/her affairs, the person or institution responsible for their care is required to apply to receive the benefit payments on the beneficiary's behalf. Representative payee applicants complete and submit Form CM-910 for evaluation to the district office that has jurisdiction over the beneficiary's claim file. Regulations 20 CFR 725.505-513 require the collection of this information.

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 if the collection of information does not display a valid OMB Control Number. See 5 CFR 1320.5(a) and 1320.6. The DOL obtains OMB approval for this information collection under OMB Control Number 1240-0010. The current OMB approval is scheduled to expire on March 31, 2012; however, it should be noted that existing information collection requirements submitted to the OMB receive a month-to-month extension while they undergo review. While not affecting the public burden, this ICR technically qualifies as a revision under the PRA. The agency has made cosmetic changes to Form CM-910 (e.g., replaced an obsolete logo with the DOL Seal and removed references to the no longer existent Employment Standards Administration). For additional information, see the related notice published in the Federal Register on January 10, 2012 (77 FR 1513).

Interested parties are encouraged to send comments to the OMB, Office of Information and Regulatory Affairs at the address shown in the ADDRESSES section within 30 days of publication of this notice in the Federal Register. In order to help ensure appropriate consideration, comments should reference OMB Control Number 1240-0010. The OMB 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.

Title of Collection: Request To Be Selected as Payee.

OMB Control Number: 1240-0010.

Affected Public: Individuals or Households.

Total Estimated Number of Respondents: 2,300.

Total Estimated Number of Responses: 2,300.

Total Estimated Annual Burden Hours: 575.

Total Estimated Annual Other Costs Burden: $1,104.

Start Signature

Dated: March 23, 2012.

Michel Smyth,

Departmental Clearance Officer.

End Signature End Supplemental Information

[FR Doc. 2012-7491 Filed 3-28-12; 8:45 am]