DOL/ESA-15, 1240-0045, 2011 clearance

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Federal Register / Vol. 67, No. 67 / Monday, April 8, 2002 / Notices

c. Doctors and medical services
providers for the purpose of obtaining
medical evaluations, physical
rehabilitation or other services.
d. Representatives of the claimant for
the purpose of processing the claim,
responsible operator and program
representation on contested issues.
e. Labor unions and other voluntary
employee associations of which the
claimant is a member for the purpose of
assisting the member.
f. Contractors providing automated
data processing services to the
Department of Labor, or to any agency
or entity to whom release is authorized,
where the contractor is providing a
service relating to the purpose for which
the information can be released.
g. Federal, state or local agencies if
necessary to obtain information relevant
to a Departmental decision concerning
the determination of initial or
continuing eligibility for program
benefits, including whether benefits
have been or are being paid improperly;
whether dual benefits prohibited under
any federal or state law are being paid;
and including salary offset and debt
collection procedures, including any
action required by the Debt Collection
Act of 1982.
h. Debt collection agency that DOL
has contracted for collection services to
recover indebtedness owed to the
United States.
i. Internal Revenue Service for the
purpose of obtaining taxpayer mailing
addresses in order to locate such
taxpayers to collect, compromise, or
write-off a Federal claim against the
taxpayer; discharging an indebtedness
owed by an individual.
j. Credit Bureaus for the purpose of
receiving consumer credit reports
identifying the assets, liabilities, income
and expenses of a debtor to ascertain the
debtor’s ability to pay a debt and to
establish a payment schedule.
Note: Disclosure to a claimant or a person
who is duly authorized to act on the
claimant’s or beneficiary’s behalf, of
information contained in the file may be
made over the telephone. Disclosure over the
telephone will only be done where the
requestor provides appropriate identifying
information to OWCP personnel. Telephonic
disclosure of information is essential to allow
OWCP to efficiently perform its functions in
adjudicating and servicing claims.
DISCLOSURE TO CONSUMER REPORTING
AGENCIES:

The amount, status and history of
overdue debts; the name and address,
taxpayer identification (SSAN), and
other information necessary to establish
the identity of a debtor, the agency and
program under which the claim arose,
are disclosed pursuant to 5 U.S.C.

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552a(b)(12) to consumer reporting
agencies as defined by the Fair Credit
Reporting Act (15 U.S.C. 1681a(f), or in
accordance with the Federal Claims
Collection Act of 1966 as amended (31
U.S.C. 3711(e) for the purpose of
encouraging the repayment of an
overdue debt.
POLICIES AND PRACTICES FOR STORING,
RETRIEVING, ACCESSING, RETAINING, AND
DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:

Case file documents, both original and
copies, in manual files.
RETRIEVABILITY:

Coal miner’s name, social security
number, and claimant’s social security
number different from miner’s.
SAFEGUARDS:

Files are located in the restricted area
of a Federal building under guard by
security officers.
RETENTION AND DISPOSAL:

Approved claims files are destroyed
10 years after death of last beneficiary.
Denied claims are destroyed 30 years
after final denial.
SYSTEM MANAGER(S) AND ADDRESS:

Director, Division of Coal Mine
Workers’ Compensation, Department of
Labor Building, Room C–3520, 200
Constitution Avenue, NW, Washington,
DC 20210, and district office directors
(see addresses in the Appendix to this
document).
NOTIFICATION PROCEDURE:

Individuals wishing to inquire
whether this system of records contains
information about them should contact
the system manager at the above
address, or district office directors. (See
addresses in the Appendix to this
document.) Individuals must furnish
claimant’s name, and signature.
RECORD ACCESS PROCEDURE:

Individuals wishing to request access
to non-exempt records should contact
the appropriate office listed in the
Notification Procedure section. The
individual must furnish his or her
name, signature and address.
CONTESTING RECORD PROCEDURES:

Specific materials in this system have
been exempted from Privacy Act
provisions (5 U.S.C. 552a(d)), regarding
access to records. The section of this
notice titled ‘‘Systems Exempted from
Certain Provisions of the Act’’ indicates
the kinds of materials exempted from
access and the reasons for exempting
them from access. Individuals wishing
to request amendment of any non-

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exempt records should contact the
appropriate office listed in the
Notification Procedure section.
Individuals must furnish their name,
address and signature.
RECORD SOURCE CATEGORIES:

Individuals, organizations, and
investigators.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS
OF THE ACT:

In accordance with 5 U.S.C.
552a(k)(2), investigatory material in this
system of records compiled for law
enforcement purposes is exempt from
subsections (c)(3); (d); (e)(1); (e)(4)(G),
(H), and (I); and (f) of 5 U.S.C. 552a,
provided however, that if any
individual is denied any right, privilege,
or benefit that he or she would
otherwise be entitled to by Federal law,
or for which he or she would otherwise
be eligible, as a result of the
maintenance of these records, such
material shall be provided to the
individual, except to the extent that the
disclosure of such material would reveal
the identity of a source who furnished
information to the Government under an
express promise that the identity of the
source would be held in confidence, or
prior to January 1, 1975, under an
implied promise that the identity of the
source would be held in confidence.
DOL/ESA–15
SYSTEM NAME:

Office of Workers’ Compensation
Programs, Longshore and Harbor
Workers’ Compensation Act Case Files.
SECURITY CLASSIFICATION:

None.
SYSTEM LOCATION:

Division of Longshore and Harbor
Workers’ Compensation, Office of
Workers’ Compensation Programs,
Washington, DC 20210, and district
offices of the Office of Workers’
Compensation Programs set forth in the
Appendix to this document.
CATEGORIES OF INDIVIDUALS COVERED BY THE
SYSTEM:

Employees injured or killed while
working in private industry who are
covered by the provisions of the
Longshore and Harbor Workers’
Compensation Act, the NonAppropriated Fund Instrumentalities
Act, the Defense Base Act, the War
Hazards Act, and the DC Workers’
Compensation Act, referred to
collectively herein as the Longshore and
Harbor Workers’ Compensation Act
(LHWCA).

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Federal Register / Vol. 67, No. 67 / Monday, April 8, 2002 / Notices
CATEGORIES OF RECORDS IN THE SYSTEM:

This system may contain the
following kinds of records: reports of
injury by the employee and/or
employing agency; claim forms filed by
or on behalf of injured employees
covered under the LHWCA or their
survivors seeking benefits under the
LHWCA; forms authorizing medical care
and treatment; other medical records
and reports; bills and other payments
records; compensation payments
records (including section 8(f) payment
records); section 8(f) applications filed
by the employer; formal orders for or
against the payment of benefits;
transcripts of hearings conducted; and
any other medical employer or personal
information submitted or gathered in
connection with the claim. The system
may also contain information relating to
dates of birth, marriage, divorce, and
death, notes of telephone conversations
conducted in connection with the claim;
information relating to vocational and/
or medical rehabilitation plans and
progress reports; records relating to
court proceedings, insurance, banking,
and employment; articles from
newspapers and insurance, banking and
employment; articles from newspapers
and other publications; information
relating to other benefits (financial and
otherwise) the claimant or employer
may be entitled to; and information
received from various investigative
agencies concerning possible violations
of Federal civil or criminal law.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:

33 U.S.C. 901 et seq. (20 CFR parts
701 et seq.); 36 DC Code 501 et seq.; 42
U.S.C. 1651 et seq.; 43 U.S.C. 1331 et
seq.; 5 U.S.C. 8171 et seq.
PURPOSE(S):

To maintain records on the actions of
insurance carriers, employers, and
injured workers with respect to injuries
reported under the Longshore and
Harbor Workers’ Compensation Act and
related Acts, to ensure that eligible
claimants receive appropriate benefits
as provided by the Act.
ROUTINE USES OF RECORDS MAINTAINED IN THE
SYSTEM, INCLUDING CATEGORIES OF USERS AND
THE PURPOSES OF SUCH USES:

In addition to those universal routine
uses listed in the General Prefatory
Statement to this document, disclosure
of information from this system of
records may also be made to the
following individuals and entities for
the purposes noted when the purpose of
the disclosure is compatible with the
purpose for which the information was
collected:
a. The employer or its representatives,
including third-party administrators,
and/or any party providing the

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employer with workers’ compensation
insurance coverage since the employer
and insurance carrier are parties-ininterest to all actions on a case, for the
purpose of assisting in the litigation of
the claim, at any time after report of the
injury or report of the onset of the
occupational illness, or the filing of a
notice of injury or claim related to such
injury or occupational illness.
b. Doctors, pharmacies, and other
health care providers for the purpose of
treating the claimant, conducting
medical examinations, physical
rehabilitation or other services or
obtaining medical evaluations.
c. Public or private rehabilitation
agencies to whom the injured worker
has been referred for vocational
rehabilitation services so that they may
properly evaluate the injured worker’s
experience, physical limitations and
future employment capabilities.
d. Federal, state and local agencies
conducting similar or related
investigations to verify whether
prohibited dual benefits were provided,
whether benefits have been or are being
paid properly, including whether dual
benefits prohibited by federal law are
being paid; salary offset and debt
collection procedures including those
actions required by the Debt Collection
Act of 1982.
e. Labor unions and other voluntary
associations from which the claimant
has requested assistance in connection
with the processing of the LHWCA
claim.
f. Attorneys or other persons
authorized to represent the interests of
the LHWCA claimant in connection
with a claim for benefits under the
LHWCA, and/or a LHWCA beneficiary
in connection with a claim for damages
filed against a third party.
g. Internal Revenue Service for the
purpose of obtaining taxpayer mailing
addresses in order to locate a taxpayer
to collect, compromise, or write-off a
Federal claim against such taxpayer;
discharging an indebtedness owed by an
individual.
h. Trust funds that have demonstrated
to the OWCP a right to a lien under 33
U.S.C. 917, for the purpose of permitting
the trust funds to identify potential
entitlement to payments upon which
the trust funds may execute the lien.
Note: Disclosure of information contained
in the file to the claimant, a person who is
duly authorized to act on his/her behalf, or
to others to whom disclosure is authorized by
these routine uses, may be made over the
telephone. Disclosure over the telephone will
only be done where the requestor provides
appropriate identifying information.
Telephonic disclosure of information is
essential to permit efficient administration
and adjudication of claims.

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16871

Note: Pursuant to 5 U.S.C. 552a(b)(1),
information from this system of records is
disclosed to members and staff of the Office
of Administrative Law Judges, the Benefits
Review Board, the Office of the Solicitor and
other components of the Department who
have a need for the record in the performance
of their duties.
DISCLOSURE TO CONSUMER REPORTING
AGENCIES:

None.
POLICIES AND PRACTICES FOR STORING,
RETRIEVING, ACCESSING, RETAINING, AND
DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:

Case files are maintained in manual
files and magnetic tapes.
RETRIEVABILITY:

Case files are retrieved after
identification by coded file number,
which is cross-referenced to injured
worker by name.
SAFEGUARDS:

Files are maintained under
supervision of OWCP personnel during
normal working hours. Files and
magnetic tapes are maintained in locked
offices after normal working hours.
Confidential passwords are required for
access to automated records.
RETENTION AND DISPOSAL:

Time retained varies by type of case,
ranging from lost-time disability cases,
in which records are destroyed 20 years
after the case is closed, to other cases
where the last possible beneficiary has
died, in which the records are destroyed
6 years and 3 months after the death of
such beneficiary. ‘‘No Lost Time’’ cases
are destroyed three years after the end
of the fiscal year during which the
related report was received.
SYSTEM MANAGER(S) AND ADDRESS:

Director for Longshore and Harbor
Workers’ Compensation, U.S.
Department of Labor, 200 Constitution
Avenue, NW, Washington, DC 20210;
and District Directors at the district
offices set forth in the Appendix.
NOTIFICATION PROCEDURE:

Requests, including name, date of
injury, employer at time of injury, and
case file number, if known, should be
addressed to the system manager listed
above, at the office where the case is
located.
RECORD ACCESS PROCEDURES:

Individuals wishing to request access
to records should contact the system
manager indicated above.
CONTESTING RECORD PROCEDURE:

Individuals wishing to contest the
contents of a record should contact the
appropriate System Manager.

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Federal Register / Vol. 67, No. 67 / Monday, April 8, 2002 / Notices

RECORD SOURCE CATEGORIES:

Information is obtained from injured
employees, their qualified dependents,
employers, insurance carriers,
physicians, medical facilities,
educational institutions, attorneys, and
State, Federal, and private vocational
rehabilitation agencies.
SYSTEM EXEMPTED FROM CERTAIN PROVISIONS
OF THE ACT:

None.
DOL/ESA–24
SYSTEM NAME:

Office of Workers’ Compensation
Programs, Longshore and Harbor
Workers’ Compensation Act Special
Fund System.
SECURITY CLASSIFICATION:

None.
SYSTEM LOCATION:

Division of Longshore and Harbor
Workers’ Compensation, Office of
Workers’ Compensation Programs, 200
Constitution Avenue, NW, Washington,
DC 20210.
CATEGORIES OF INDIVIDUALS COVERED BY THE
SYSTEM:

Persons receiving compensation and
related benefits under the Longshore
and Harbor Workers’ Compensation Act,
the Non-Appropriated Fund
Instrumentalities Act, the Defense Base
Act, the War Hazards Act, and the DC
Workers’ Compensation Act, referred to
collectively herein as the Longshore and
Harbor Workers’ Compensation Act
(LHWCA).
CATEGORIES OF RECORDS IN THE SYSTEM:

Medical and vocational rehabilitation
reports, bills, vouchers and records of
payment for compensation and related
benefits, statements of employment
status, and formal orders for payment of
compensation, and U.S. Treasury
Records.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:

33 U.S.C. 901 et seq. (20 CFR parts
701 et seq.); 36 DC Code 501 et seq.; 42
U.S.C. 1651 et seq.; 43 U.S.C. 1331 et
seq.; 5 U.S.C. 8171 et seq.;
PURPOSE(S):

This system provides a record of
payments to claimants, their qualified
dependents, or providers of services to
claimants from the Special Fund
established pursuant to Section 44 of
the Act.
ROUTINE USES OF RECORDS MAINTAINED IN THE
SYSTEM, INCLUDING CATEGORIES OF USERS AND
THE PURPOSES OF SUCH USES:

In addition to those universal routine
uses listed in the General Prefatory

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Statement to this document, disclosure
of information from this system of
records may also be made to the
following individuals and entities for
the purposes noted when the purpose of
the disclosure is compatible with the
purpose for which the information was
collected:
a. The employer or employer’s
representatives, including third-party
administrators, and/or any party
providing the employer with workers’
compensation insurance coverage since
the employer and insurance carrier are
parties-in-interest to all actions on a
case, for the purpose of assisting in the
litigation of the claim, at any time after
report of the injury or report of the onset
of the occupational illness, or the filing
of a notice of injury or claim related to
such injury or occupational illness.
b. Doctors, pharmacies, and other
health care providers for the purpose of
treating the claimant, conducting
medical examinations, physical
rehabilitation or other services or
obtaining medical evaluations.
c. Public or private rehabilitation
agencies to whom the injured worker
has been referred for vocational
rehabilitation services so that they may
properly evaluate the injured worker’s
experience, physical limitations and
future employment capabilities.
d. Federal, state and local agencies
conducting similar or related
investigations to verify whether
prohibited dual benefits were provided,
whether benefits have been or are being
paid properly, including whether dual
benefits prohibited by federal law are
being paid; salary offset and debt
collection procedures including those
actions required by the Debt Collection
Act of 1982.
e. Labor unions and other voluntary
associations from which the claimant
has requested assistance with the
processing of the LHWCA claim.
f. Internal Revenue Service for the
purpose of obtaining taxpayer mailing
addresses in order to locate such
taxpayer to collect, compromise, or
write-off a Federal claim against the
taxpayer; discharging an indebtedness
owed by an individual.
g. Trust funds that have demonstrated
to the OWCP a right to a lien under 33
U.S.C. 917, for the purpose of permitting
the trust funds to identify potential
entitlement to payments upon which
the trust funds may execute the lien.
h. To individuals, and their attorneys
and other representatives, and
government agencies, seeking to enforce
a legal obligation on behalf of such
individual, to pay alimony and/or child
support, for the purpose of enforcing
such an obligation, pursuant to an order

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of a state or local court of competent
jurisdiction, including Indian tribal
courts, within any State, territory or
possession of the United States, or the
District of Columbia or to an order of a
State agency authorized to issue income
withholding notices pursuant to State or
local law or pursuant to the
requirements of section 666(b) of title
42, United States Code, or for the
purpose of denying the existence of
funds subject to such legal obligation.
Note: Disclosure of information contained
in the file to the claimant, a person who is
duly authorized to act on his/her behalf, or
to others to whom disclosure is authorized by
these routine uses, may be made over the
telephone. Disclosure over the telephone will
only be done where the requestor provides
appropriate identifying information.
Telephonic disclosure of information is
essential to permit efficient administration
and adjudication of claims.
Note: Information from this system of
records is disclosed to members and staff of
the Office of Administrative Law Judges, the
Benefits Review Board, the Office of the
Solicitor and other components of the
Department who have a need for the record
in the performance of their duties.
DISCLOSURE TO CONSUMER REPORTING
AGENCIES:

None.
POLICIES AND PRACTICES FOR STORING,
RETRIEVING, ACCESSING, RETAINING, AND
DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:

Case files are maintained in manual
files and magnetic tapes.
RETRIEVABILITY:

Case files are retrieved by social
security number, which is crossreferenced to injured worker by name.
SAFEGUARDS:

Files are maintained under
supervision of OWCP personnel during
normal working hours. Confidential
passwords are required for access to
automated records. Files and magnetic
tapes are in Federal office building.
RETENTION AND DISPOSAL:

Files are destroyed 7 years after last
payment is made.
SYSTEM MANAGER(S) AND ADDRESS:

Director for Longshore and Harbor
Workers’ Compensation, Office of
Workers’ Compensation Programs, 200
Constitution Avenue, NW, Washington,
DC 20210.
NOTIFICATION PROCEDURE:

Requests, including name and case
number, if known, should be addressed
to the System Manager.

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