Skip to Content


Agency Information Collection Activities; Submission for OMB Review; Comment Request; Notice of Law Enforcement Officer's Injury or Occupational Disease and Notice of Law Enforcement Officer's Death

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, “Notice of Law Enforcement Officer's Injury or Occupational Disease and Notice of Law Enforcement Officer's Death,” 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 November 29, 2013.


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 of charge from the Web site at​public/​do/​PRAViewICR?​ref_​nbr=​201306-1240-006 Start Printed Page 64980(this link will only become active 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, 725 17th Street NW., Washington, DC 20503, Fax: 202-395-6881 (this is not a toll-free number), email: Commenters are encouraged, but not required, to send a courtesy copy of any comments to the U.S. Department of Labor—OASAM, Office of the Chief Information Officer, Attn: Information Management Program, Room N1301, 200 Constitution Avenue NW., Washington, DC 20210, email:

Start Further Info


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

Start Authority

Authority: 44 U.S.C. 3507(a)(1)(D).

End Authority End Further Info End Preamble Start Supplemental Information


As appropriate, a respondent files a Notice of Law Enforcement Officer's Injury or Occupational Disease, Form CA-721, or Notice of Law Enforcement Officer's Death, Form (CA-722), when seeking Federal Employees' Compensation Act (5 U.S.C. 8191 et seq.) benefits for a non-Federal law enforcement officer's injury, occupational illness, or death. The forms provide the OWCP with basic information needed to process a claim made for injury, illness, or death. This ICR has been classified as a revision, because—in accordance with Department of the Treasury requirements for all Federal benefits payments to be made electronically—Forms CA-721 and CA-722 have been changed to include space and instructions for claimants to provide direct deposit information. In addition, rather than requesting the claimant's signature, Form CA-722 has been revised to request the signature of the person filing the claim. Both forms have also been revised to include an accommodation statement informing claimants with mental or physical limitations to contact the OWCP, Division of Federal Employees' Compensation if they need further assistance with the claims process.

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 that does not display a valid Control Number. See 5 CFR 1320.5(a) and 1320.6. The DOL obtains OMB approval for this information collection under Control Number 1240-0022. The current approval is scheduled to expire on October 31, 2013; however, it should be noted that existing information collection requirements submitted to the OMB receive a month-to-month extension while they undergo review. New requirements would only take effect upon OMB approval. For additional substantive information about this ICR, see the related notice published in the Federal Register on July 5, 2013 (78 FR 40513).

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 mention OMB Control Number 1240-0022. 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: Notice of Law Enforcement Officer's Injury or Occupational Disease and Notice of Law Enforcement Officer's Death.

OMB Control Number: 1240-0022.

Affected Public: Individuals or Households.

Total Estimated Number of Respondents: 10.

Total Estimated Number of Responses: 10.

Total Estimated Annual Burden Hours: 14.

Total Estimated Annual Other Costs Burden: $5.

Start Signature

Dated: October 24, 2013.

Michel Smyth,

Departmental Clearance Officer.

End Signature End Supplemental Information

[FR Doc. 2013-25630 Filed 10-29-13; 8:45 am]