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Agency Information Collection Activities; Submission for OMB Review; Comment Request; Death Gratuity

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Information about this document as published in the Federal Register.

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

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The Department of Labor (DOL) is submitting the Office of Workers' Compensation Programs (OWCP) sponsored information collection request (ICR) revision titled, “Death Gratuity,” 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.). Public comments on the ICR are invited.


The OMB will consider all written comments that agency receives on or before September 16, 2016.


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=​201603-1240-001 (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, TTY 202-693-8064, (these are not toll-free numbers) or sending an email to

Submit comments about this request by mail or courier 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; by Fax: 202-395-5806 (this is not a toll-free number); or by email: Commenters are encouraged, but not required, to send a courtesy copy of any comments by mail or courier to the U.S. Department of Labor-OASAM, Office of the Chief Information Officer, Attn: Departmental Information Compliance Management Program, Room N1301, 200 Constitution Avenue NW., Washington, DC 20210; or by email:

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Michel Smyth by telephone at 202-693-4129, TTY 202-693-8064, (these are not toll-free numbers) or sending an email to

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

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This ICR seeks approval under the PRA for revisions to the Death Gratuity Forms. The National Defense Authorization Act for Fiscal Year 2008, Public Law 110-181, amended the Federal Employees' Compensation Act (FECA) by establishing a FECA death gratuity benefit of up to $100,000 for eligible beneficiaries of Federal employees and Non-Appropriated Fund Instrumentality employees who die from injuries incurred in connection with service with an Armed Force in a contingency operation. The OWCP associates three forms with this ICR. Form CA-40 requests information necessary from an employee who chooses to name alternate beneficiaries from those otherwise established by law. Form CA-41 provides the means for those named beneficiaries to file benefit claims. Information provided by such claimants allows the OWCP to determine payment eligibility. The statute and regulations also require Agencies to notify the OWCP immediately upon the death of a covered employee, and Form CA-42 provides the means to accomplish this notification. This latter form requests information necessary to administer any claim for benefits resulting from such a death. The Federal Employee Compensation Act authorizes this information collection. See 5 U.S.C. 8145, 8149.

This information collection has been classified as a revision, because of changes to the forms. For example, each form has enhanced the statement informing respondents with disabilities how they may obtain assistance in filing a claim. A certification on Form CA-41 has also been clarified and direct deposit information has been added.

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 1240-0017. The current approval is scheduled to expire on August 31, 2016; however, the DOL notes 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 April 13, 2016 (81 FR 21905).

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 thirty (30) days of publication of this notice in the Federal Register. In order to help ensure appropriate consideration, comments should mention OMB Control Number 1240-0017. 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.Start Printed Page 54853

Agency: DOL-OWCP.

Title of Collection: Death Gratuity.

OMB Control Number: 1240-0017.

Affected Public: Individuals or Households.

Total Estimated Number of Respondents: 262.

Total Estimated Number of Responses: 262.

Total Estimated Annual Time Burden: 67 hours.

Total Estimated Annual Other Costs Burden: $0.

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Dated: August 10, 2016.

Michel Smyth,

Departmental Clearance Officer.

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[FR Doc. 2016-19614 Filed 8-16-16; 8:45 am]