[Federal Register Volume 80, Number 141 (Thursday, July 23, 2015)]
[Notices]
[Pages 43800-43801]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-18001]
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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 extension of the existing collection:
Uniform Billing Form (OWCP-04). A copy of the proposed information
collection request can be obtained by contacting the office listed
below in the addresses section of this Notice.
[[Page 43801]]
DATES: Written comments must be submitted to the office listed in the
addresses section below on or before September 21, 2015.
ADDRESSES: Ms. Yoon Ferguson, U.S. Department of Labor, 200
Constitution Ave. NW., Room S-3323, Washington, DC 20210, telephone/fax
(202) 354-9647, 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 of these statutes require that OWCP pay
for medical treatment of beneficiaries; this medical treatment can
include inpatient/outpatient hospital services, as well as services
provided by nursing homes, skilled nursing facilities and home health
aides in the home. In order to determine whether billed amounts are
appropriate, OWCP needs to identify the patient, the specific services
that were rendered and their relationship to the work-related injury or
illness. The regulations implementing these statutes require the use of
Form OWCP-04 or UB-04 for the submission of medical bills from
institutional providers (20 CFR 10.801, 30.701, 725.405, 725.406,
725.701 and 725.704). The Uniform Billing form, known as the paper UB-
04, has been approved by the American Hospital Association, the Centers
for Medicare and Medicaid Services and the Civilian Health and Medical
Program of Uniformed Services (CHAMPUS), by various other government
health care providers, and the private sector, to request payment to
institutional providers of medical services. The paper UB-04 has been
designed by the National Uniform Billing Committee and is neither a
government-printed form nor distributed by OWCP. However, this
collection includes the paper UB-04 as a collection instrument, with
detailed instructions prepared by OWCP to ensure that it obtains only
the information needed to consider requests for payment from
institutional providers using this billing form. This information
collection is currently approved for use through January 31, 2016.
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 covered
medical services to beneficiaries who are covered under FECA, BLBA and
EEOICPA.
Type of Review: Extension.
Agency: Office of Workers' Compensation Programs.
Title: Uniform Billing Form.
OMB Number: 1240-0019.
Agency Number: OWCP-04.
Affected Public: Individuals or households; Businesses or other
for-profit; Not-for-profit institutions.
Total Respondents: 6,277.
Total Responses: 221,992.
Time per Response: 1-7 minutes
Estimated Total Burden Hours: 25,503.
Total Burden Cost (capital/startup): $0.
Total Burden Cost (operating/maintenance): $0.
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: July 17, 2015.
Yoon Ferguson,
Agency Clearance Officer, Office of Workers' Compensation Programs, US
Department of Labor.
[FR Doc. 2015-18001 Filed 7-22-15; 8:45 am]
BILLING CODE 4510-CR-P