[Federal Register Volume 77, Number 180 (Monday, September 17, 2012)]
[Notices]
[Page 57161]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-22829]


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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Proposed Extension of Existing Collection; Comment Request

ACTION: Notice.

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SUMMARY: The Department of Labor, as part of its continuing effort to 
reduce paperwork and respondent burden, conducts a preclearance 
consultation program to provide the general public and Federal agencies 
with an opportunity to comment on proposed and/or continuing 
collections of information in accordance with the Paperwork Reduction 
Act of 1995 (PRA95) [44 U.S.C. 3506(c)(2)(A)]. This program 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 is soliciting 
comments concerning the proposed collection: Claim for Medical 
Reimbursement (OWCP-915). A copy of the proposed information collection 
request can be obtained by contacting the office listed below in the 
addresses section of this Notice.

DATES: Written comments must be submitted to the office listed in the 
addresses section below on or before November 16, 2012.

ADDRESSES: Ms Yoon Ferguson, U.S. Department of Labor, 200 Constitution 
Ave. NW., Room S-3201, Washington, DC 20210, telephone (202) 693-0701, 
fax (202) 693-2447, Email [email protected]. Please use only one 
method of transmission for comments (mail, fax, or Email).

SUPPLEMENTARY INFORMATION:
    I. Background: The Office of Workers' Compensation Programs (OWCP) 
is the agency responsible for administration of the Federal Employees' 
Compensation Act (FECA), 5 U.S.C. 8101 et seq., the Black Lung Benefits 
Act (BLBA), 30 U.S.C. 901 et seq., and the Energy Employees 
Occupational Illness Compensation Program Act of 2000 (EEOICPA), 42 
U.S.C. 7384 et seq. All three statutes require OWCP to pay for covered 
medical treatment that is provided to beneficiaries, and also to 
reimburse beneficiaries for any out-of-pocket covered medical expenses 
they have paid. Form OWCP-915, Claim for Medical Reimbursement, is used 
for this purpose and collects the necessary beneficiary and medical 
provider data in a standard format. Regulations implementing the FECA, 
BLBA and EEOICPA programs require the collection of information that is 
needed to determine if reimbursement claims submitted by beneficiaries 
can be paid. (20 CFR 10.802, 30.702, 725.701 and 725.705). This 
information collection is currently approved for use through December 
31, 2012.
    II. Review Focus: The Department of Labor is particularly 
interested in comments which:
     Evaluate whether the proposed collection of information is 
necessary for the proper performance of the functions of the agency, 
including whether the information will have practical utility;
     Evaluate the accuracy of the agency's estimate of the 
burden of the proposed collection of information, including the 
validity of the methodology and assumptions used;
     Enhance the quality, utility and clarity of the 
information to be collected; and
     Minimize the burden of the collection of information 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 submissions of responses.
    III. Current Actions: The Department of Labor seeks the approval of 
the extension of this currently approved information collection in 
order to carry out its responsibility to provide payment for certain 
covered medical services to injured employees who are covered under the 
Acts.
    Type of Review: Extension.
    Agency: Office of Workers' Compensation Programs.
    Title: Claim for Medical Reimbursement.
    OMB Number: 1240-0007.
    Agency Number: OWCP-915.
    Affected Public: Individual or Households; Business or other-for-
profit; Not-for-profit institutions.
    Total Respondents: 8,309.
    Total Responses: 25,872.
    Time per Response: 10 minutes.
    Estimated Total Burden Hours: 4,294.
    Total Burden Cost (capital/startup): $0.
    Total Burden Cost (operating/maintenance): $42,689.
    Comments submitted in response to this notice will be summarized 
and/or included in the request for Office of Management and Budget 
approval of the information collection request; they will also become a 
matter of public record.

    Dated: September 12, 2012.
Yoon Ferguson,
Agency Clearance Officer, Office of Workers' Compensation Programs, 
U.S. Department of Labor.
[FR Doc. 2012-22829 Filed 9-14-12; 8:45 am]
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