Billing Code:

4510-CH-P

DEPARTMENT OF LABOR
Office of Workers’ Compensation Programs
Proposed Revision of Information Collection; FECA Medical
Report Forms, Claim for Compensation, OMB Control No. 12400046
AGENCY:

Office of Workers’ Compensation Programs, 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, the Office of Workers’ Compensation

Programs, Division of Federal Employees’ Longshore and
Harbor Workers’ Compensation, (OWCP/DFELHWC) is soliciting
comments on the information collection for FECA Medical

Report Forms, Claim for Compensation, Authorization for
Examination And/Or Treatment, CA-16.
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-2024-0014. 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 DOL- OWCP/DFELHWC,
Office of Workers’ Compensation Programs, Division of
Federal Employees’ Longshore and Harbor Workers’
Compensation, U.S. Department of Labor, 200
Constitution Ave., NW, Room S-3323, Washington,
DC

•

OWCP/DFELHWC 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, Division of Federal
Employees’ Longshore, and Harbor Workers’ Compensation,
OWCP/DFELHWC, at suggs.anjanette@dol.gov @dol.gov (email);
(202) 354-9660.
SUPPLEMENTARY INFORMATION:
I.

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

administers the Federal Employees’ Compensation Act (FECA),
which provides for continuation of pay or compensation 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 allowing for an
individual to make a claim for compensation benefits is

found at 5 U.S.C. 8102, Compensation for disability or
death of employee, and reads as follows:
(a) The United States shall pay compensation as specified
by this subchapter for the disability or death of an
employee resulting from personal injury sustained while in
the performance of his duty, unless the injury or death is—
(1) caused by willful misconduct of the employee;
(2) caused by the employee's intention to bring about the
injury or death of himself or of another; or
(3) proximately caused by the intoxication of the injured
employee.
(b) Disability or death from a war-risk hazard or during or
as a result of capture, detention, or other restraint by a
hostile force or individual, suffered by an employee who is
employed outside the continental United States or in Alaska
or in the areas and installations in the Republic of Panama
made available to the United States pursuant to the Panama
Canal Treaty of 1977 and related agreements (as described
in section 3(a) of the Panama Canal Act of 1979), is deemed
to have resulted from personal injury sustained while in
the performance of his duty, whether or not the employee
was engaged in the course of employment when the disability
or disability resulting in death occurred or when he was

taken by the hostile force or individual.

This subsection

does not apply to an individual—
(1) whose residence is at or in the vicinity of the place
of his employment and who was not living there solely
because of the exigencies of his employment, unless he was
injured or taken while engaged in the course of his
employment; or
(2) who is a prisoner of war or a protected individual
under the Geneva Conventions of 1949 and is detained or
utilized by the United States.

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.

References: 5 U.S.C. 8102, 5 U.S. C. 8103, and 5 U.S.C.
8149. 20 CFR 10.102, 20 CFR 10.211, 20 CFR 10.300, 20 CFR
10.314, 20 CFR. 314, and 20 CFR. 10.506.
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/DFELHWC is soliciting comments concerning the

proposed information collection related to the FECA Medical
Report Forms, Claim for Compensation, Authorization for
Examination And/Or Treatment, CA-16.

OWCP/DFELHWC 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/DFELHWC’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/DFELHWC located at 200 Constitution Ave.,
NW, Room S-3323, 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 FECA
Medical Report Forms, Authorization for Examination And/Or
Treatment, CA-16.

OWCP/DFELHWC has updated the data with

respect to the number of respondents, responses, burden
hours, and burden costs supporting this information
collection request from the previous information collection
request.
Type of Review:

Revision of a currently approved

collection.
Agency:

Office of Workers’ Compensation Programs, Division

of Federal Employees’ Longshore, and Harbor Workers’
Compensation, OWCP/DFELHWC.
OMB Number: 1240-0046.
Affected Public:
profits.

Private Sector – Business or other For-

Number of Respondents: 248,981.
Frequency: On Occasion.
Number of Responses: 248,981.
Annual Burden Hours: 22,824 hours.
Annual Respondent or Recordkeeper Cost:

$186,736.00.

OWCP/DFELHWC 1240-0046: OWCP/DFELHWC FECA Medical Report
Forms, Authorization for Examination and/or Treatment.
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. 2024-13438 Filed: 6/18/2024 8:45 am; Publication Date: 6/20/2024]