Agency Information Collection Activities; Submission for OMB Review; Comment Request; Uniform Billing Form, 70826-70827 [2012-28658]
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70826
Federal Register / Vol. 77, No. 228 / Tuesday, November 27, 2012 / Notices
Authority: 44 U.S.C. 3507(a)(1)(D).
The DOL
periodically conducts customer
satisfaction surveys and conference
evaluations that help assess
Departmental products and services.
Responses help lead to improvements in
areas deemed necessary. These
information collections are 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 1225–0059. 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 September 30, 2012 (77 FR
55506).
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 1225–
0059. 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,
wreier-aviles on DSK5TPTVN1PROD with
SUPPLEMENTARY INFORMATION:
VerDate Mar<15>2010
15:05 Nov 26, 2012
Jkt 229001
e.g., permitting electronic submission of
responses.
Agency: DOL.
Title of Collection: DOL Generic
Solution for Customer Satisfaction
Surveys and Conference Evaluations.
OMB Control Number: 1225–0059.
Affected Public: Individuals or
Households; Private Sector—businesses
or other for profits, farms, and not-forprofit institutions; Federal Government;
and State, Local, and Tribal
Governments.
Total Estimated Number of
Respondents: 375,000.
Total Estimated Number of
Responses: 375,000.
Total Estimated Annual Burden
Hours: 37,500.
Total Estimated Annual Other Costs
Burden: $0.
Dated: November 19, 2012.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2012–28622 Filed 11–26–12; 8:45 a.m.]
BILLING CODE 4510–23–P
DEPARTMENT OF LABOR
Office of the Secretary
Agency Information Collection
Activities; Submission for OMB
Review; Comment Request; Uniform
Billing Form
ACTION:
Notice.
The Department of Labor
(DOL) is submitting the Office of
Workers’ Compensation Programs
(OWCP) sponsored information
collection request (ICR) revision titled,
‘‘Uniform Billing Form,’’ (Form OWCP–
04) to the Office of Management and
Budget (OMB) for review and approval
for use in accordance with the
Paperwork Reduction Act (PRA) of
1995.
SUMMARY:
Submit comments on or before
December 27, 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
DATES:
PO 00000
Frm 00090
Fmt 4703
Sfmt 4703
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).
The
OWCP requires an institutional medical
provider providing any services to a
beneficiary covered under the Federal
Employee’s Compensation Act, Black
Lung Benefits Act, or Energy Employees
Occupational Illness Compensation
Program Act of 2000 to bill using a form
based on the industry standard, Form
UB–04. Form OWCP–04 identifies the
beneficiary, the type of services
provided, the conditions being treated,
and the billed amounts. This
information enables the OWCP to pay
providers for covered services.
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 1240–0019. 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
51830).
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–
0019. The OMB is particularly
interested in comments that:
• Evaluate whether the proposed
collection of information is necessary
SUPPLEMENTARY INFORMATION:
E:\FR\FM\27NON1.SGM
27NON1
Federal Register / Vol. 77, No. 228 / Tuesday, November 27, 2012 / Notices
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: Uniform Billing
Form.
OMB Control Number: 1240–0019.
Affected Public: Private Sector—
businesses or other for-profits and notfor-profit institutions.
Total Estimated Number of
Respondents: 6,947.
Total Estimated Number of
Responses: 229,997.
Total Estimated Annual Burden
Hours: 26,599.
Total Estimated Annual Other Costs
Burden: $0.
Dated: November 19, 2012.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2012–28658 Filed 11–26–12; 8:45 am]
BILLING CODE 4510–CR–P
DEPARTMENT OF LABOR
Office of the Secretary
Agency Information Collection
Activities; Submission for OMB
Review; Comment Request; Request to
the Department of Labor for Expedited
Review of Denial of COBRA Premium
Reduction
ACTION:
Notice.
The Department of Labor
(DOL) is submitting the Employee
Benefits Security Administration
(EBSA) sponsored information
collection request (ICR) titled, ‘‘Request
to the Department of Labor for
Expedited Review of Denial of COBRA
Premium Reduction,’’ to the Office of
Management and Budget (OMB) for
review and approval for continued use
in accordance with the Paperwork
Reduction Act (PRA) of 1995 (44 U.S.C.
3501 et seq.).
wreier-aviles on DSK5TPTVN1PROD with
SUMMARY:
VerDate Mar<15>2010
15:05 Nov 26, 2012
Jkt 229001
Submit comments on or before
December 27, 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–EBSA, 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:
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.
DATES:
Authority: 44 U.S.C. 3507(a)(1)(D).
American
Recovery and Reinvestment Act of 2009
(ARRA) section 3001 provides an
assistance eligible individual with the
right to pay reduced health benefits
premiums under the Consolidated
Omnibus Budget Reconciliation Act of
1986, commonly called COBRA, for up
to 9 months. If an individual requests
treatment as an assistance eligible
individual and is denied such treatment
because of COBRA continuation
coverage ineligibility, ARRA section
3001(a)(5) requires the Secretary of
Labor to provide for expedited review of
the denial upon application to the
Secretary in the form and manner the
Secretary provides. The Secretary of
Labor is required to act in consultation
with the Secretary of the Treasury and
must make a determination within 15
business days after receipt of an
individual’s application for review. The
Application to the Department of Labor
for Expedited Review of Denial of
COBRA Premium Reduction is the form
used by individuals to file their
expedited review appeals. Such
individuals must complete all
information requested on the
Application in order to file their review
requests with the EBSA. The ICR relates
to the Application.
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
SUPPLEMENTARY INFORMATION:
PO 00000
Frm 00091
Fmt 4703
Sfmt 4703
70827
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 1210–0135. 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 June 25, 2012 (77 FR 37920).
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 1210–
0135. 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–EBSA.
Title of Collection: Request to the
Department of Labor for Expedited
Review of Denial of COBRA Premium
Reduction.
OMB Control Number: 1210–0135.
Affected Public: Individuals or
Households and Private Sector—
businesses or other for-profits and notfor-profit institutions.
Total Estimated Number of
Respondents: 184.
E:\FR\FM\27NON1.SGM
27NON1
]]>Agencies
[Federal Register Volume 77, Number 228 (Tuesday, November 27, 2012)]
[Notices]
[Pages 70826-70827]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-28658]
-----------------------------------------------------------------------
DEPARTMENT OF LABOR
Office of the Secretary
Agency Information Collection Activities; Submission for OMB
Review; Comment Request; Uniform Billing 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, ``Uniform Billing Form,'' (Form OWCP-04)
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 27, 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: The OWCP requires an institutional medical
provider providing any services to a beneficiary covered under the
Federal Employee's Compensation Act, Black Lung Benefits Act, or Energy
Employees Occupational Illness Compensation Program Act of 2000 to bill
using a form based on the industry standard, Form UB-04. Form OWCP-04
identifies the beneficiary, the type of services provided, the
conditions being treated, and the billed amounts. This information
enables the OWCP to pay providers for covered services.
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 1240-0019. 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 51830).
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 1240-0019.
The OMB is particularly interested in comments that:
Evaluate whether the proposed collection of information is
necessary
[[Page 70827]]
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: Uniform Billing Form.
OMB Control Number: 1240-0019.
Affected Public: Private Sector--businesses or other for-profits
and not-for-profit institutions.
Total Estimated Number of Respondents: 6,947.
Total Estimated Number of Responses: 229,997.
Total Estimated Annual Burden Hours: 26,599.
Total Estimated Annual Other Costs Burden: $0.
Dated: November 19, 2012.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2012-28658 Filed 11-26-12; 8:45 am]
BILLING CODE 4510-CR-P
