Agency Information Collection Activities; Submission for OMB Review; Comment Request; Health Insurance Claim Form, 67834 [2012-27609]
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Federal Register / Vol. 77, No. 220 / Wednesday, November 14, 2012 / Notices
and any individual Commissioner’s
statements will be available from the
Office of the Secretary and at the
Commission’s Web site.
Authority: These reviews are being
conducted under authority of title VII of the
Tariff Act of 1930; this notice is published
pursuant to section 207.62 of the
Commission’s rules.
Issued: November 8, 2012.
By order of the Commission.
Lisa R. Barton,
Acting Secretary to the Commission.
[FR Doc. 2012–27640 Filed 11–13–12; 8:45 am]
BILLING CODE 7020–02–P
DEPARTMENT OF LABOR
Office of the Secretary
Agency Information Collection
Activities; Submission for OMB
Review; Comment Request; Health
Insurance Claim Form
ACTION:
Notice.
The Department of Labor
(DOL) is submitting the Office of
Workers’ Compensation Programs
(OWCP) sponsored information
collection request (ICR) revision titled,
‘‘Health Insurance Claim Form,’’ (Form
OWCP–1500) to the Office of
Management and Budget (OMB) for
review and approval for use in
accordance with the Paperwork
Reduction Act (PRA) of 1995.
DATES: Submit comments on or before
December 14, 2012.
ADDRESSES: A copy of this ICR with
applicable supporting documentation;
including a description of the likely
respondents, proposed frequency of
response, and estimated total burden
may be obtained from the RegInfo.gov
Web site, https://www.reginfo.gov/
public/do/PRAMain, on the day
following publication of this notice or
by contacting Michel Smyth by
telephone at 202–693–4129 (this is not
a toll-free number) or sending an email
to DOL_PRA_PUBLIC@dol.gov.
Submit comments about this request
to the Office of Information and
Regulatory Affairs, Attn: OMB Desk
Officer for DOL–OWCP, Office of
Management and Budget, Room 10235,
725 17th Street NW., Washington, DC
20503, Fax: 202–395–6881 (this is not a
toll-free number), email:
OIRA_submission@omb.eop.gov.
FOR FURTHER INFORMATION CONTACT:
Michel Smyth by telephone at 202–693–
4129 (this is not a toll-free number) or
by email at DOL_PRA_PUBLIC@dol.gov.
emcdonald on DSK67QTVN1PROD with NOTICES
SUMMARY:
Authority: 44 U.S.C. 3507(a)(1)(D).
VerDate Mar<15>2010
14:41 Nov 13, 2012
Jkt 229001
OWCP
and contractor bill payment staff use
Form OWCP–1500 to process bills for
medical services provided by medical
professionals other than medical
services provided by hospitals,
pharmacies, or certain other medical
providers. This information is required
to pay health care providers for services
rendered to injured employees covered
under OWCP-administered programs.
Appropriate payment cannot be made
without documentation of the medical
services provided by the health care
provider billing the OWCP. The OWCP
uses information obtained to identify
the patient and determine benefit
eligibility. The OWCP also uses the
information to decide whether services
and supplies received are covered by
OWCP programs and to assure that
proper payment is made.
This information collection is subject
to the PRA. A Federal agency generally
cannot conduct or sponsor a collection
of information, and the public is
generally not required to respond to an
information collection, unless it is
approved by the OMB under the PRA
and displays a currently valid OMB
Control Number. In addition,
notwithstanding any other provisions of
law, no person shall generally be subject
to penalty for failing to comply with a
collection of information if the
collection of information does not
display a valid Control Number. See 5
CFR 1320.5(a) and 1320.6. The DOL
obtains OMB approval for this
information collection under Control
Number 1240–0044. The current
approval is scheduled to expire on
November 30, 2012; however, it should
be noted that existing information
collection requirements submitted to the
OMB receive a month-to-month
extension while they undergo review.
For additional information, see the
related notice published in the Federal
Register on August 27, 2012 (77 FR
51828).
Interested parties are encouraged to
send comments to the OMB, Office of
Information and Regulatory Affairs at
the address shown in the ADDRESSES
section within 30 days of publication of
this notice in the Federal Register. In
order to help ensure appropriate
consideration, comments should
mention OMB Control Number 1240–
0044. The OMB is particularly
interested in comments that:
• 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;
SUPPLEMENTARY INFORMATION:
PO 00000
Frm 00045
Fmt 4703
Sfmt 4703
• 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 submission of
responses.
Agency: DOL–OWCP.
Title of Collection: Health Insurance
Claim Form.
OMB Control Number: 1240–0044.
Affected Public: Private Sector—
businesses or other for-profits.
Total Estimated Number of
Respondents: 71,304.
Total Estimated Number of
Responses: 3,036,067.
Total Estimated Annual Burden
Hours: 322,838.
Total Estimated Annual Other Costs
Burden: $0.
Dated: November 7, 2012.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2012–27609 Filed 11–13–12; 8:45 am]
BILLING CODE 4510–CR–P
NATIONAL AERONAUTICS AND
SPACE ADMINISTRATION
[Notice: 12–097]
Notice of Information Collection
National Aeronautics and
Space Administration (NASA).
ACTION: Notice of information collection
AGENCY:
The National Aeronautics and
Space Administration, as part of its
continuing effort to reduce paperwork
and respondent burden, invites the
general public and other Federal
agencies to take this opportunity to
comment on proposed and/or
continuing information collections, as
required by the Paperwork Reduction
Act of 1995 (Pub. L. 104–13, 44 U.S.C.
3506(c)(2)(A)).
DATES: All comments should be
submitted within 30 calendar days from
the date of this publication.
ADDRESSES: Interested persons are
invited to submit written comments on
the proposed information collection to
the Office of Information and Regulatory
Affairs, Office of Management and
SUMMARY:
E:\FR\FM\14NON1.SGM
14NON1
]]>Agencies
[Federal Register Volume 77, Number 220 (Wednesday, November 14, 2012)]
[Notices]
[Page 67834]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-27609]
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-----------------------------------------------------------------------
DEPARTMENT OF LABOR
Office of the Secretary
Agency Information Collection Activities; Submission for OMB
Review; Comment Request; Health Insurance Claim Form
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Department of Labor (DOL) is submitting the Office of
Workers' Compensation Programs (OWCP) sponsored information collection
request (ICR) revision titled, ``Health Insurance Claim Form,'' (Form
OWCP-1500) to the Office of Management and Budget (OMB) for review and
approval for use in accordance with the Paperwork Reduction Act (PRA)
of 1995.
DATES: Submit comments on or before December 14, 2012.
ADDRESSES: A copy of this ICR with applicable supporting documentation;
including a description of the likely respondents, proposed frequency
of response, and estimated total burden may be obtained from the
RegInfo.gov Web site, https://www.reginfo.gov/public/do/PRAMain, on the
day following publication of this notice or by contacting Michel Smyth
by telephone at 202-693-4129 (this is not a toll-free number) or
sending an email to DOL_PRA_PUBLIC@dol.gov.
Submit comments about this request to the Office of Information and
Regulatory Affairs, Attn: OMB Desk Officer for DOL-OWCP, Office of
Management and Budget, Room 10235, 725 17th Street NW., Washington, DC
20503, Fax: 202-395-6881 (this is not a toll-free number), email:
OIRA_submission@omb.eop.gov.
FOR FURTHER INFORMATION CONTACT: Michel Smyth by telephone at 202-693-
4129 (this is not a toll-free number) or by email at DOL_PRA_PUBLIC@dol.gov.
Authority: 44 U.S.C. 3507(a)(1)(D).
SUPPLEMENTARY INFORMATION: OWCP and contractor bill payment staff use
Form OWCP-1500 to process bills for medical services provided by
medical professionals other than medical services provided by
hospitals, pharmacies, or certain other medical providers. This
information is required to pay health care providers for services
rendered to injured employees covered under OWCP-administered programs.
Appropriate payment cannot be made without documentation of the medical
services provided by the health care provider billing the OWCP. The
OWCP uses information obtained to identify the patient and determine
benefit eligibility. The OWCP also uses the information to decide
whether services and supplies received are covered by OWCP programs and
to assure that proper payment is made.
This information collection is subject to the PRA. A Federal agency
generally cannot conduct or sponsor a collection of information, and
the public is generally not required to respond to an information
collection, unless it is approved by the OMB under the PRA and displays
a currently valid OMB Control Number. In addition, notwithstanding any
other provisions of law, no person shall generally be subject to
penalty for failing to comply with a collection of information if the
collection of information does not display a valid Control Number. See
5 CFR 1320.5(a) and 1320.6. The DOL obtains OMB approval for this
information collection under Control Number 1240-0044. The current
approval is scheduled to expire on November 30, 2012; however, it
should be noted that existing information collection requirements
submitted to the OMB receive a month-to-month extension while they
undergo review. For additional information, see the related notice
published in the Federal Register on August 27, 2012 (77 FR 51828).
Interested parties are encouraged to send comments to the OMB,
Office of Information and Regulatory Affairs at the address shown in
the ADDRESSES section within 30 days of publication of this notice in
the Federal Register. In order to help ensure appropriate
consideration, comments should mention OMB Control Number 1240-0044.
The OMB is particularly interested in comments that:
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 submission of responses.
Agency: DOL-OWCP.
Title of Collection: Health Insurance Claim Form.
OMB Control Number: 1240-0044.
Affected Public: Private Sector--businesses or other for-profits.
Total Estimated Number of Respondents: 71,304.
Total Estimated Number of Responses: 3,036,067.
Total Estimated Annual Burden Hours: 322,838.
Total Estimated Annual Other Costs Burden: $0.
Dated: November 7, 2012.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2012-27609 Filed 11-13-12; 8:45 am]
BILLING CODE 4510-CR-P
