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Agency Information Collection Activities; Submission for OMB Review; Comment Request; Request for Information on Earnings, Dual Benefits, Dependents, and Third-Party Settlements

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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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On May 31, 2017, the Department of Labor (DOL) will submit the Office of Workers' Compensation Programs (OWCP) sponsored information collection request (ICR) revision titled, “Request for Information on Earnings, Dual Benefits, Dependents, and Third-Party Settlements,” to the Office of Management and Budget (OMB) for review and approval for use in accordance with the Paperwork Reduction Act (PRA) of 1995. Public comments on the ICR are invited.


The OMB will consider all written comments that agency receives on or before June 30, 2017.


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=​201701-1240-003 (this link will only become active on June 1, 2017) 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 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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This ICR seeks approval under the PRA for revisions to the Request for Information on Earnings, Dual Benefits, Dependents, and Third-Party Settlements (Form CA-1032, Form EN-1032) information collection. The OWCP uses this collection to obtain information from a Federal Employees' Compensation Act (FECA) claimant receiving workers' compensation benefits over an extended period. The OWCP uses the response to determine whether the claimant is entitled to continue receiving benefits and whether the benefit amount should be adjusted. The collection is necessary to ensure the beneficiary receives correct compensation. This information collection has been classified as a revision, because OWCP has made several clarifications to the data collection. The FECA authorizes this information collection. See 5 U.S.C. 8124 and 8149.

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 1240-0016. The current approval is scheduled to expire on May 31, 2017; 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 February 27, 2017 (82 FR 11946).

Interested parties are encouraged to send comments to the OMB, Office of Information and Regulatory Affairs at the address shown in the ADDRESSES section by June 30, 2017. In order to help ensure appropriate consideration, comments should mention OMB Control Number 1240-0016. 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 for Information on Earnings, Dual Benefits, Dependents, and Third-Party Settlements.

OMB Control Number: 1240-0016.

Affected Public: Individuals or Households.

Total Estimated Number of Respondents: 45,161.

Total Estimated Number of Responses: 45,161.

Total Estimated Annual Time Burden: 15,054 hours.

Total Estimated Annual Other Costs Burden: $9,935.

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

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Dated: May 17, 2017.

Michel Smyth,

Departmental Clearance Officer.

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[FR Doc. 2017-10565 Filed 5-22-17; 8:45 am]