Billing Code:

4510-CH-P

DEPARTMENT OF LABOR
Office of the Worker’s Compensation Programs
Proposed New Information Collection; Form CA-21, Attending
Physician’s Certification of Continuing Workers’
Compensation Disability
(OMB Control No. 1240-0NEW)
AGENCY: Office of Workers’ Compensation, Division of Federal
Employees’ Longshore and Harbor Workers’ Compensation,
(OWCP/DFELHWC), Labor.
ACTION:
SUMMARY:

Request for public comments.
The Department of Labor, as part of its

continuing effort to reduce paperwork and respondent
burden, conducts a pre-clearance request for comment to
provide the general public and Federal agencies with an
opportunity to comment on proposed collections of
information in accordance with the Paperwork Reduction Act
of 1995.

This request helps to ensure that: 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 on respondents can be properly
assessed.

Currently, OWCP/DFELHWC is soliciting comments

on the new information collection for Attending Physician’s
Certification of Continuing Workers’ Compensation

Disability, CA-21.
DATES:

All comments must be received on or before [INSERT

DATE 60 DAYS AFTER DATE OF PUBLICATION IN THE FEDERAL
REGISTER].
ADDRESSES:

You may submit comment as follows.

Please note

that late, untimely filed comments will not be considered.
Electronic Submissions:

Submit electronic comments in the

following way:
•

Federal eRulemaking Portal:
https://www.regulations.gov.

Follow the instructions

for submitting comments for WCPO-2024-0012. Comments
submitted electronically, including attachments, to
https://www.regulations.gov will be posted to the
docket, with no changes. Because your comment will be
made public, you are responsible for ensuring that
your comment does not include any confidential
information that you or a third party may not wish to
be posted, such as your or anyone else’s Social
Security number or confidential business information.
•

If your comment includes confidential information that
you do not wish to be made available to the public,
submit the comment as a written/paper submission.

Written/Paper Submissions:

Submit written/paper

submissions in the following way:

•

Mail/Hand Delivery: Mail or visit U.S. DOL-Office of
Workers’ Compensation Programs, OWCP, Room S3323, 200
Constitution Avenue NW, Washington, DC 20210;

•

OWCP will post your comment as well as any
attachments, except for information submitted and
marked as confidential, in the docket at
https://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT:

Anjanette Suggs, Office

of Workers’ Compensation Programs, OWCP, at
suggs.anjanette@dol.gov (email); (202) 354–9660(voice).
SUPPLEMENTARY INFORMATION:
I.

Background
The Office of Worker’s Compensation Programs (OWCP)

administers the Federal Employees’ Compensation Act (FECA),
which provides for medical and compensation benefits for
work related injuries or disease from federal employment.
5 U.S.C. § 8149, Congress gives the Secretary of Labor
authority to prescribe the rules and regulations necessary
for the administration and enforcement of the FECA.
The relevant statutory provision 5 U.S.C. § 8103, Medical
services and initial medical and other benefits, which
reads as follows:
(a) The United States shall furnish to an employee who is
injured while in the performance of duty, the services,
appliances, and supplies prescribed or recommended by a
qualified physician, which the Secretary of Labor considers

likely to cure, give relief, reduce the degree or the
period of disability, or aid in lessening the amount of the
monthly compensation. These services, appliances, and
supplies shall be furnished-(1) whether or not disability has arisen;
(2) notwithstanding that the employee has accepted or is
entitled to receive benefits under subchapter III of
chapter 83 of this title or another retirement system for
employees of the Government; and
(3) by or on the order of United States medical officers
and hospitals, or, at the employee's option, by or on the
order of physicians and hospitals designated or approved by
the Secretary. The employee may initially select a
physician to provide medical services, appliances, and
supplies, in accordance with such regulations and
instructions as the Secretary considers necessary, and may
be furnished necessary and reasonable transportation and
expenses incident to the securing of such services,
appliances, and supplies. These expenses, when authorized
or approved by the Secretary, shall be paid from the
Employees' Compensation Fund.
(b) The Secretary, under such limitations or conditions as
he considers necessary, may authorize the employing
agencies to provide for the initial furnishing of medical
and other benefits under this section. The Secretary may

certify vouchers for these expenses out of the Employees'
Compensation Fund when the immediate superior of the
employee certifies that the expense was incurred in respect
to an injury which was accepted by the employing agency as
probably compensable under this subchapter. The Secretary
shall prescribe the form and content of the certificate.
In accordance with 20 CFR 10.330, OWCP requires each
employee who is receiving benefits to provide a medical
report from their attending physician.

Per 20 CFR 10.332,

OWCP will request the attending physician to provide a
report at periodic intervals in all cases requiring
hospital treatment or prolonged care.

The attending

physician will be asked to describe the continuing need for
medical treatment for the accepted condition, prognosis,
description of work tolerance limitations, and the
physician’s opinion on causal relationship between the
diagnosed condition and the employee’s work factors.
Further, 20 CFR 10.501 states:
(a) The employee is responsible for providing sufficient
medical evidence to justify payment of any compensation
sought.
(1) To support payment of continuing compensation where
an employee has been found entitled to periodic benefits,
narrative medical evidence must be submitted whenever
OWCP requests it but ordinarily not less than once a year

and with any filing of a form CA-1032. It must contain a
physician's rationalized opinion as to whether the
specific period of alleged disability is causally related
to the employee's accepted injury or illness.
(2) For those employees with more serious conditions not
likely to improve and for employees over the age of 65,
OWCP may require less frequent documentation, but
ordinarily not less than once every three years.
References: 5 U.S.C.

8149, 5 U.S.C. 8103, 20 CFR 10.330,

20 CFR 10.332, and 20 CFR. 10.501.
See: https://www.dol.gov/owcp/dfec/regs/statutes/feca.htm#)
See:

eCFR :: 20 CFR Part 10 -- Claims for Compensation

Under the Federal Employees' Compensation Act, as Amended
II.

Desired Focus of Comments
OWCP is soliciting comments concerning the proposed

information collection related to the Attending Physician’s
Certification of Continuing Workers’ Compensation
Disability.

OWCP is particularly interested in comments

that:
•

Evaluate whether the collection of information is
necessary for the proper performance of the functions
of the Agency, including whether the information has
practical utility;

•

Evaluate the accuracy of OWCP’s estimate of the burden
related to the information collection, including the
validity of the methodology and assumptions used in
the estimate;

•

Suggest methods to enhance the quality, utility, and
clarity of the information to be collected; and

•

Minimize the burden of the information collection 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.
Background documents related to this information

collection request are available at https://regulations.gov
and at DOL-OWCP located at U.S. Department of Labor, Office
of Workers' Compensation Programs, Room S3323, 200
Constitution Avenue NW, Washington, DC 20210.

Questions

about the information collection requirements may be
directed to the person listed in the FOR FURTHER
INFORMATION section of this notice.
III. Current Actions
This information collection request concerns Attending
Physician’s Certification of Continuing Workers’
Compensation Disability, CA-21.
Type of Review:
Agency:

New collection.

DOL-Office of Workers’ Compensation Programs

OMB Number: 1240-0NEW
Affected Public: Private Sector – Businesses or other forprofits.
Number of Respondents:

33,372.

Frequency: On Occasion.
Number of Responses: 33,372.
Annual Burden Hours: 2,670 hours.
Annual Respondent or Recordkeeper Cost: $25,029.00.
OWCP Forms: OWCP Form CA-21, Attending Physician’s
Certification of Continuing Workers’ Compensation
Disability.
Comments submitted in response to this notice will be
summarized in the request for Office of Management and
Budget approval of the proposed information collection
request; they will become a matter of public record and
will be available at https://www.reginfo.gov.

Anjanette Suggs,
Certifying Officer.

[FR Doc. 2024-13437 Filed: 6/18/2024 8:45 am; Publication Date: 6/20/2024]