Dol/govt-15

DOL GOVT-15.pdf

Certification of Funeral Expenses

DOL/GOVT-15

OMB: 1240-0040

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16870

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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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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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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Federal Register / Vol. 67, No. 67 / Monday, April 8, 2002 / Notices
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
System Manager indicated above.
RECORD SOURCE CATEGORIES:

The system obtains information 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.

the reporting side of the total system.
The Office of Contract Compliance
Programs Case Management System
(OFCMS) provides the umbrella under
which numerous applications can be
accessed. The purposes of the systems
are: To track and monitor by means of
an automated data base complaint
investigations of employment
discrimination by Federal contractors.
To provide OFCCP Managers with a
viable means of tracking the number of
hours used in performing OFCCP
program responsibilities. To track the
number of hours utilized by compliance
officers in performing their assigned
program duties and responsibilities.
ROUTINE USES OF RECORDS MAINTAINED IN THE
SYSTEM, INCLUDING CATEGORIES OF USERS AND
THE PURPOSES OF SUCH USES:

None, except for those universal
routine uses listed in the General
Prefatory Statement to this document.

DOL/ESA–25
SYSTEM NAME:

Office of Federal Contract Compliance
Programs, Executive Management
Information System (OFCCP/EIS) which
includes the Case Management System
(CMS), and Time Reporting Information
System (TRIS).
SECURITY CLASSIFICATION:

DISCLOSURE TO CONSUMER REPORTING
AGENCIES:

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

Unclassified.
SYSTEM LOCATION:

OFCCP, Department of Labor, 200
Constitution Avenue, NW, Washington,
DC 20210; Ten Regional Offices, see the
Appendix to this document for
addresses.
CATEGORIES OF INDIVIDUALS COVERED BY THE
SYSTEM:

Individuals filing complaints of
employment discrimination by Federal
Contractors and Compliance Officers.
CATEGORIES OF RECORDS IN THE SYSTEM:

Listing of hours utilized to perform
OFCCP program responsibilities. Listing
of complaints filed by individuals
alleging employment and listing of
hours utilized to perform OFCCP
program responsibilities.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:

Manual files for working copies of
source documents and magnetic tapes
and disks for central computer
processing.
RETRIEVABILITY:

By the name of the complainant,
OFCCP control number, contractor
establishment name and number. By
identification numbers assigned to each
compliance officer.
SAFEGUARDS:

Files are locked except during
working hours, and only authorized
personnel have access to files. Computer
systems are restricted to authorized
operators and each subsystem has
multiple layers of password protection
depending upon sensitivity of data.
RETENTION AND DISPOSAL:

Executive Order 11246, as amended;
the Vietnam Era Veterans’ Readjustment
Assistance Act of 1974, as amended, 38
U.S.C. 2012; section 503 of the
Rehabilitation Act of 1973, as amended,
29 U.S.C. 793.

Inactive records retained in system for
two years from last date of action on
record before being purged to history
files where they are stored for three
years. Transfer to NARA and destroy
five years after transfer.

PURPOSE(S):

SYSTEM MANAGER(S) AND ADDRESS:

The Case Management System is the
data entry portion of OFCCP’s core case
management and management
information system. OFCCP Executive
Information System (OFEIS) makes up

Director, OFCCP, Room C–3325, 200
Constitution Avenue, NW, Washington,
DC 20210; Regional Directors for
OFCCP, see Appendix I to this
document for Addresses.

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NOTIFICATION PROCEDURES:

Individuals wishing to inquire
whether this system of records contains
information about them should contact
the appropriate system manager or the
Regional Office servicing the state
where they are employed (see list of the
Regional Office addresses in Appendix).
Such person should provide his or her
full name, date of birth, and signature.
RECORD ACCESS PROCEDURES:

A request for access shall be mailed
or presented to the appropriate system
manager at the address listed above.
Individuals must furnish the following
information for their records to be
identified: (a) Name and (b) verification
of identity as required by the regulations
implementing the Privacy Act of 1974,
at 29 CFR 71.2.
CONTESTING RECORD PROCEDURES:

Individuals wishing to contest
information in their files may write the
appropriate system manager at the
specified address, reasonably
identifying the records pertaining to
them, the information which is being
contested in that record, the corrective
action(s) being sought, and the reason
for the correction(s). See also 29 CFR
71.9.
RECORD SOURCE CATEGORIES:

OFCCP personnel working in district
and regional offices.
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 the source would be held
in confidence.
DOL/ESA–26
SYSTEM NAME:

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

None.

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

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:

Individuals filing claims for workers’
compensation benefits under 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); individuals providing
medical and other services to the
Division; employees of insurance
companies and of medical and other
services providers to claimants; and
other persons suspected of violations of
law under the Act, including related
civil and criminal provisions.
CATEGORIES OF RECORDS IN THE SYSTEM:

Records which contain information
gathered in connection with
investigations concerning possible
violations of Federal law, whether civil
or criminal, under the LHWCA. This
system also contains the work product
of the Department of Labor and other
government personnel and consultants
involved in the investigations.
AUTHORITY FOR MAINTENANCE OF 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 for the purpose
of assisting in determinations of
possible violations of Federal law,
whether civil or criminal, in connection
with reported injuries under the
LHWCA.
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 relevant and necessary 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: Internal
Revenue Service, for the purpose of
obtaining taxpayer mailing addresses in

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order to locate a taxpayer to collect,
compromise, or write-off a Federal
claim against such taxpayer; discharging
an indebtedness owed by an individual.
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:

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
System Manager.
RECORD SOURCE CATEGORIES:

Records are from Division claim and
payment files (DOL/ESA–15 and DOL/
ESA–24) and from employees, insurers,
service providers; and information
received from parties leading to the
opening of an investigation, or from
interviews held during the course of an
investigation.
SYSTEM EXEMPTED FROM CERTAIN PROVISIONS
OF THE ACT:

STORAGE:

Records are maintained in manual
files.
RETRIEVABILITY:

Records are retrieved by name of
individual being investigated.
SAFEGUARDS:

Files are maintained under the
supervision of OWCP personnel and
access is provided only to authorized
personnel.
RETENTION AND DISPOSAL:

Time retained varies by type of
compensation case involved, and the
investigative file is retained according to
the same schedule as the particular
compensation case to which it relates.
For example, if the investigative file is
about a lost-time case, it is transferred
to the Federal Records Center 2 years
after the related compensation case is
closed, and destroyed 20 years after the
case is closed. If the investigative file is
about a death case, it is retained in the
office as long as there are qualified
dependents, and destroyed 6 years, 3
months after final closing. ‘‘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, Office of
Workers’ Compensation Programs, 200
Constitution Avenue, NW, Washington,
DC 20210, and District Directors in the
district offices of the Office of Workers’
Compensation Programs set forth in the
Appendix to this document.

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–27
SYSTEM NAME:

Office of Workers’ Compensation
Programs, Longshore and Harbor
Workers’ Compensation Act Claimant
Representatives.
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.

NOTIFICATION PROCEDURE:

CATEGORIES OF INDIVIDUALS COVERED BY THE
SYSTEM:

Requests, including name of
individual being investigated, should be
addressed to the System Manager.

Individuals alleged to have violated
the provisions of the Longshore and
Harbor Workers’ Compensation Act and

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Federal Register / Vol. 67, No. 67 / Monday, April 8, 2002 / Notices
its implementing regulations relating to
representation of claimants/
beneficiaries before the Department of
Labor, those found to have committed
such violations and who have been
disqualified, and those who are
investigated but not disqualified. This
system would also cover those persons
who have been reinstated as qualified
claimant representatives.
CATEGORIES OF RECORDS IN THE SYSTEM:

Records in the system will consist of
information such as the representative’s
name and address, the names and
addresses of affected claimants/
beneficiaries, copies of relevant
documents obtained from claimant/
beneficiary files relating to the issue of
representation; all documents received
or created as a result of the investigation
of and/or hearing on the alleged
violation of the Longshore Act and/or its
regulations relating to representation,
including investigations conducted by
the DOL Office of Inspector General or
other agency; and copies of documents
notifying the representative and other
interested persons of the
disqualification.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:

Longshore and Harbor Workers’
Compensation Act, 33 U.S.C.
931(b)(2)(B).
These records contain information on
activities—including billing— relating
to representation of claimants/
beneficiaries, including documents
relating to the debarment of
representatives under other Federal or
state programs.
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 relevant and necessary 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. A claimant/beneficiary for the
purpose of informing him/her that his/
her representative has been disqualified
from further representation under the
Longshore Act.
b. Employers, insurance carriers, state
bar disciplinary authorities, and the
general public, for the purpose of
providing information concerning the
qualification of person(s) to act as a
claimant representative under the Act.

19:00 Apr 05, 2002

Jkt 197001

Note: Disclosure of information contained
in the file of 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.

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 PROCEDURES FOR STORING,
RETRIEVING, ACCESSING, RETAINING AND
DISPOSING OF RECORDS IN THIS SYSTEM:
STORAGE:

PURPOSE(S):

VerDate 112000

c. Federal, state or local agency
maintaining pertinent records, if
necessary to obtain information relevant
to a Departmental decision relating to
debarment actions.

The information collected in
connection with complaints is kept in
manual files.
RETRIEVABILITY:

The records are retrieved by the name
of the representative.
SAFEGUARDS:

Records are stored in locked file
cabinets.
RETENTION AND DISPOSAL:

File is retained in the office for three
years after the debarment action is final
and then transferred to the Federal
Records Center, and destroyed thirty
years after the debarment action is final.
Where the period of exclusion is
defined as a set period of time, the file
will be retained two years after the
period of exclusion expires (or the
individual is otherwise reinstated), then
transferred to the Federal Records
Center, and destroyed thirty years after
the debarment action is final.

16875

NOTIFICATION PROCEDURE:

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

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

Individuals wishing to contest the
contents of a record should contact the
System Manager.
RECORD SOURCE CATEGORIES:

Information in this system is obtained
from employees, employers, insurance
carriers, members of the public, agency
investigative reports, and from other
DOL systems of records.
SYSTEM 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–28
SYSTEM NAME:

Office of Workers’ Compensation
Programs, Physicians and Health Care
Providers Excluded under the
Longshore Act.
SECURITY CLASSIFICATION:

None.

SYSTEM MANAGER(S) AND ADDRESS:

SYSTEM LOCATION:

Director for Longshore and Harbor
Workers’ Compensation Act, Office of
Workers’ Compensation Programs, 200
Constitution Avenue, NW, Washington,
DC 20210, and District Directors in
district offices set forth in the
Appendix.

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.

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16876

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

CATEGORIES OF INDIVIDUALS COVERED BY THE
SYSTEM:

Providers of medical goods and
services, including physicians,
hospitals, and providers of medical
support services or supplies excluded or
considered for exclusion from payment
under the Longshore Act, 33 U.S.C.
907(c).
CATEGORIES OF RECORDS IN THE SYSTEM:

Copies of letters, lists, and documents
from Federal and state agencies
concerning the administrative
debarment of providers from
participation in programs providing
benefits similar to those of the
Longshore and Harbor Workers’
Compensation Act and their
reinstatement; materials concerning
possible fraud or abuse which could
lead to exclusion of a provider;
documents relative to reinstatement of
providers; materials concerning the
conviction of providers for fraudulent
activities in connection with any
Federal or state program for which
payments are made to providers for
similar medical services; all letters,
memoranda, and other documents
regarding the consideration of a
provider’s exclusion, the actual
exclusion, or reinstatement under the
provisions of 20 CFR 702.431 et seq.;
copies of all documents in a claimant’s
file relating to medical care and/or
treatment, including bills for such
services; as well as letters, memoranda,
and other documents obtained during
investigations, hearings, and other
administrative proceedings concerning
exclusion for fraud or abuse, as well as
reinstatement, and recommendations
and decisions; lists of excluded
providers released by the OWCP.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:

Longshore and Harbor Workers’
Compensation Act, 33 U.S.C. 901,
907(c).
PURPOSE(S):

To maintain records to determine the
propriety of instituting debarment
actions under the Longshore Act. These
records also provide information on
treatment, billing and other aspects of a
medical provider’s actions, and/or
documentation relating to the
debarment of the medical care provider
under another Federal or state program.
ROUTINE USES OF RECORDS MAINTAINED IN THE
SYSTEM, INCLUDING CATEGORIES OF USERS AND
THE PURPOSE 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 be made to the following

VerDate 112000

19:00 Apr 05, 2002

Jkt 197001

individuals and entities for the purposes
noted when the purpose of the
disclosure is compatible with the
purpose for which the information is
collected:
a. Federal, state or local government
agencies, state licensing boards,
professional organizations, claimants,
patients, employers, insurance
companies, and any other entities or
individuals, for the purpose of
identifying an excluded or reinstated
provider, to ensure that authorization is
not issued nor payment made to an
excluded provider, and for the purpose
of providing notice that a formerly
excluded provider has been reinstated.
b. Federal, state or local government
agencies, state licensing boards,
professional organizations, claimants,
patients, employers, insurance
companies, and any other entities or
individuals, for the purpose of obtaining
information necessary to ensure that the
list of excluded providers is correct,
useful, and updated, as appropriate, and
for the purpose of obtaining information
relevant to a Departmental decision
regarding a debarment action. This
routine use encompasses the disclosure
of such information which will enable
the Department to properly verify the
identity of a provider, to identify the
nature of a violation, and the penalty
imposed for such violation.

RETRIEVABILITY:

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.

An individual wishing to inquire
whether this system of records contains
information about him/her may write
the system manager at the address
above. In order for the record to be
located, the individual must provide his
or her full name, date of birth, and
signature.

Note: Pursuant to 5 U.S.C. 552a(b)(1),
information from this system of records is
disclosed to members and staff of the
Benefits Review Board, the Office of
Administrative Law Judges, 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 PROCEDURES FOR STORING,
RETRIEVING, ACCESSING, RETAINING, AND
DISPOSING OF RECORDS IN THIS SYSTEM:
STORAGE:

The records are in manual files,
magnetic tapes or other computer
storage media, or on computer
printouts.

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Material is maintained by the name of
the provider.
SAFEGUARDS:

Material in the possession of the
Office of Workers’ Compensation
Programs and its contractors will be,
when not in use, kept in closed file
cabinets, appropriate lockers and
storage areas, etc.
RETENTION AND DISPOSAL:

File is retained in the office for three
years after the debarment action is final
and then transferred to the Federal
Records Center, and destroyed thirty
years after the debarment action is final.
Where the period of exclusion is
defined as a set period of time, the file
will be retained two years after the
period of exclusion expires (or the
individual is otherwise reinstated), then
transferred to the Federal Records
Center, and destroyed thirty years after
the debarment action is final.
SYSTEM MANAGER(S) AND ADDRESS:

Director for Longshore and Harbor
Workers’ Compensation Act, Office of
Workers’ Compensation Programs, 200
Constitution Avenue, NW, Washington,
DC 20210, and District Directors in the
district offices set forth in the Appendix
to this document.
NOTIFICATION PROCEDURE:

RECORD ACCESS PROCEDURE:

Any individual seeking access to nonexempt information about a record
within this system of records may write
the appropriate system manager, and
arrangements will be made to provide
review of the file. In order for the record
to be located, the individual must
provide his or her full name, date of
birth, and signature.
CONTESTING RECORD PROCEDURE:

Specific materials in this system have
been exempted from certain Privacy Act
provisions regarding the amendment of
records. The section of this notice
entitled ‘‘Systems Exempted from
Certain Provisions of the Act’’ indicates
the kind of materials exempted, and the
reasons for exempting them. Any
individual requesting amendment of
non-exempt records should contact the
appropriate system manager. In order
for the record to be located, the

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Federal Register / Vol. 67, No. 67 / Monday, April 8, 2002 / Notices
individual must provide his or her full
name, date of birth, and signature.
Individuals requesting amendment of
records must comply with the
Department’s Privacy Act regulations at
29 CFR 71.1 and 71.9.
RECORD SOURCE CATEGORIES:

Information in this system is obtained
from Federal, state or local government
agencies, state licensing boards,
professional organizations, claimants,
patients, employers, insurance
companies, any other entities or
individuals, public documents, and
newspapers, as well as from other
Department of Labor systems of records.
SYSTEM 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–29
SYSTEM NAME:

SECURITY CLASSIFICATION:

None.
SYSTEM LOCATION:

The Division of Federal Employees’
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:

Providers of medical goods and
services, including physicians,
hospitals, and providers of medical
support services or supplies excluded or

19:00 Apr 05, 2002

Jkt 197001

CATEGORIES OF RECORDS IN THE SYSTEM:

Copies of letters, lists and documents
from Federal and state agencies
concerning the administrative
debarment of providers from
participation in programs providing
benefits similar to those of the Federal
Employees’ Compensation Act and their
reinstatement; materials concerning
possible fraud or abuse which could
lead to exclusion of a provider;
documents relative to reinstatement of
providers, materials concerning the
conviction of providers for fraudulent
activities in connection with any
Federal or state program for which
payments are made to providers for
similar medical services; all letters,
memoranda, and other documents
regarding the consideration of a
provider’s exclusion, the actual
exclusion, or reinstatement under the
provisions of 20 CFR 10.815–826; copies
of all documents in a claim file relating
to medical care and/or treatment
including bills for such services, as well
as letters, memoranda, and other
documents obtained during
investigations, hearings and other
administrative proceedings concerning
exclusion for fraud or abuse, as well as
reinstatement, along with
recommendations and decisions; lists of
excluded providers released by the
OWCP.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:

Federal Employees’ Compensation
Act (5 U.S.C. 8101 et seq.), and Title 20
CFR part 10.
PURPOSE(S):

Office of Workers’ Compensation
Programs, Physicians and Health Care
Providers Excluded under the Federal
Employees’ Compensation Act.

VerDate 112000

considered for exclusion from payment
under the Federal Employees’
Compensation Act for fraud or abuse (20
CFR 10.815–826).

To maintain records to determine the
propriety of instituting debarment
actions under the Federal Employees’
Compensation Act. These records also
provide information on treatment,
billing and other aspects of a medical
provider’s actions, and/or
documentation relating to the
debarment of the medical care provider
under another Federal or state program.
ROUTINE USES OF RECORDS MAINTAINED IN THE
SYSTEM, INCLUDING CATEGORIES OF USERS AND
THE PURPOSE 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 be made to the following
individuals and entities for the purposes
noted when the purpose of the
disclosure is compatible with the

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16877

purpose for which the information is
collected:
a. Federal, state or local government
agencies, state licensing boards,
professional organizations, claimants,
patients, employers, insurance
companies, and any other entities or
individuals, for the purpose of
identifying an excluded or reinstated
provider, to ensure that authorization is
not issued nor payment made to an
excluded provider, and for the purpose
of providing notice that a formerly
excluded provider has been reinstated.
b. Federal, state or local government
agencies, state licensing boards,
professional organizations, claimants,
patients, employers, insurance
companies, and any other entities or
individuals, for the purpose of obtaining
information necessary to ensure that the
list of excluded providers is correct,
useful, and updated, as appropriate, and
for the purpose of obtaining information
relevant to a Departmental decision
regarding a debarment action. This
routine use encompasses the disclosure
of such information that will enable the
Department to properly verify the
identity of a provider, to identify the
nature of a violation, and the penalty
imposed for such violation.
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: Pursuant to 5 U.S.C. 552a(b)(1),
information from this system of records is
disclosed to members and staff of the
Employees’ Compensation Appeals Board,
the Office of Administrative Law Judges, 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 PROCEDURES FOR STORING,
RETRIEVING, ACCESSING, RETAINING, AND
DISPOSING OF RECORDS IN THIS SYSTEM:
STORAGE:

The records are in manual files,
magnetic tapes or other computer
storage media, or on computer
printouts.
RETRIEVABILITY:

Material is maintained either by the
name of the provider, a case citation, or
date of release.

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File Typeapplication/pdf
File Modified2011-02-08
File Created2002-04-08

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