Dol/esa-30

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May 10, 2006

DOL Home > SOL > Privacy Act Systems > DOL/ESA-30

DOL/ESA-30
SYSTEM NAME:

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Office of Workers' Compensation Programs, Black Lung Automated Support Package.

SECURITY CLASSIFICATION:
Unclassified.

SYSTEM LOCATION:
Office of Workers' Compensation Programs, Division of Coal Mine Workers' Compensation, U.S.
Department of Labor Building, 200 Constitution Ave., NW, Washington, DC 20210, and district
offices (see addresses in the Appendix to this document).

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Organization Charts

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Individuals filing claims for black lung benefits; claimants receiving benefits; dependents of
claimants and beneficiaries; medical providers; attorneys representing claimants; coal mine
operators (workers' compensation insurance carriers).

PURPOSE(S):

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ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING
CATEGORIES OF USERS AND THE PURPOSES OF SUCH USES:

National

Resources/
Information

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To maintain data on claimants, beneficiaries and their dependents; attorneys representing
claimants; medical service providers; coal mine operators and insurance carriers. Provide means of
automated payment of medical and disability benefits. Maintain a history of medical bills submitted
by beneficiaries and medical service providers. Maintain a history of disability benefit payments
made to beneficiaries and medical benefit payments made to beneficiaries and medical service
providers. Maintain program accounting information including information on debts owed to the
United States. Provide a means for the automatic recoupment of overpayments made to
beneficiaries and medical service providers.

Immediate

Office

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30 U.S.C. 901 et seq., 20 CFR 715.1 et seq., 20 CFR 720.1 et seq., 20 CFR 725.1 et seq.

Regional

Offices

Offices

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:

National

Divisions

Divisions

Records included are personal (name, date of birth, SSN, claim type, miner's date of death);
demographic (state, county, city, congressional district, zip code); mine employment history;
medical records; initial determination; conference results; hearing results; medical and disability
payment history; accounting information including data on debts owed to the United States; Social
Security Administration black lung benefits data; state workers' compensation claim and benefits
data; coal mine operator names, addresses, states of operation and histories of insurance
coverage; and medical service providers names, addresses, license numbers, medical specialties,
tax identifications and payment histories.

Immediate

Office

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:

CATEGORIES OF RECORDS IN THE SYSTEM:

The

Solicitor

DOL Job

Federal

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Opportunities
In addition to those universal routine uses listed in the General Prefatory Statement to this
document , disclosure of relevant and necessary information may be made to the following:
a. Mine operators (and/or any party providing the operator with workers' compensation insurance)
who have been determined potentially liable for the claim at any time after the filing of a notice of
injury or claim related to such injury or occupational illness, for the purpose of determining liability
for payment.
b. State workers' compensation agencies and the Social Security Administration for the purpose of
determining offsets as specified under the Act.
c. Doctors and medical services providers for the purpose of obtaining medical evaluations,
physical rehabilitation or other services.
d. Other Federal agencies conducting scientific research concerning the incidence and prevention
of black lung disease.
e. Legal representatives, or person authorized to act on behalf of the claimant, responsible
operator and program representation on contested issues.
f. Labor unions and other voluntary employee associations of which the claimant is a member for
the purpose of exercising an interest in claims of members as part of their service to the members.
g. 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.
h. Federal, state or local agencies if necessary to obtain information relevant to a Department
decision concerning the determination of initial or continuing eligibility for program benefits,
whether benefits have been or are being paid improperly, including whether dual benefits
prohibited under any federal or state law are being paid; and salary offset and debt collection
procedures, including any action required by the Debt Collection Act of 1982, 31 U.S.C. 3711.
i. Debt collection agency that DOL has contracted for collection services to recover indebtedness
owed to the United States.
j. Internal Revenue Service for the purpose of obtaining taxpayer mailing addresses in order to
locate taxpayers to collect, compromise, or write-off a Federal claim against the taxpayer;
discharging an indebtedness owed by an individual.
k. 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 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.
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. 552a(b)(12) to consumer
reporting agencies as defined by section 603(f) of the Fair Credit Reporting Act (15 U.S.C. 1681a
(f); or in accordance with section 3(d)(4)(A)(ii) of the Federal Claims Collection Act of 1966 as
amended (31 U.S.C. 3711(f) for the purpose of encouraging the repayment of an overdue debt.

POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING,
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Honors

Program

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RETAINING, AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
Magnetic media. Medical bills and supporting medical reports transferred to microfilm and
magnetic media.

RETRIEVABILITY:
Coal miner's name and social security number; medical provider number; coal mine operator
number; insurance carrier number.

SAFEGUARDS:
Files secured in a guarded facility; teleprocessing access protected by restrictions on access to
equipment and through use of encrypted passwords.

RETENTION AND DISPOSAL:
Electronic file data has permanent retention. Claimant and benefit master file data will be
transferred to magnetic tape and transmitted to NARA every ten years. This data (which includes
both open and closed cases) will not be made available to the public until 90 years after transfer to
NARA due to Privacy Act restrictions.

SYSTEM MANAGER(S) AND ADDRESS:
Director, Division of Coal Mine Workers' Compensation, U.S. Department of Labor, Room C-3520,
200 Constitution Ave., NW, Washington, DC 20210, and district office director (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 director (see addresses
in the Appendix to this document). Individuals must furnish their name, address, and signature.

RECORD ACCESS PROCEDURES:
Individuals wishing to access any records should contact the appropriate office listed in the
Notification Procedure section. Individuals must furnish their name, address and signature.

CONTESTING RECORD PROCEDURES:
Individuals wishing to request amendment of any non-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, and organizations.

SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
Investigatory portion of system exempted from certain provisions of the ACT: In accordance with
paragraph 3(k)(2) of the Privacy Act, investigatory material compiled for civil law enforcement
purposes, which is maintained in this system's files of the Office of Workers' Compensation
Programs of the Employment Standards Administration, is exempt from paragraphs (c)(3), (d),(e)
(1),(e)(4) (G), (H), and (I), and paragraph (f) of 5 U.S.C. 552a. The disclosure of civil
investigatory information, if any, contained in this system's files, including the names of persons

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and agencies to whom the information has been transmitted, would substantially compromise the
effectiveness of investigations. Knowledge of such investigations would enable subjects to take
such action as is necessary to prevent detection of illegal activities, conceal evidence, or otherwise
escape civil enforcement action. Disclosure of this information could lead to the intimidation of, or
harm to informants, witnesses, and their respective families, and in addition, could jeopardize the
safety and well-being of investigative personnel and their families.
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