Agency Information Collection Activities; Submission for OMB Review; Comment Request; Uniform Billing Form, 8994-8995 [2016-03736]

Download as PDF 8994 Federal Register / Vol. 81, No. 35 / Tuesday, February 23, 2016 / Notices DEPARTMENT OF LABOR Office of the Secretary Agency Information Collection Activities; Submission for OMB Review; Comment Request; Claim for Medical Reimbursement Form ACTION: Notice. The Department of Labor (DOL) is submitting the Office of Workers’ Compensation Programs (OWCP) sponsored information collection request (ICR) titled, ‘‘Claim for Medical Reimbursement Form,’’ to the Office of Management and Budget (OMB) for review and approval for continued use, without change, in accordance with the Paperwork Reduction Act of 1995 (PRA), 44 U.S.C. 3501 et seq. Public comments on the ICR are invited. DATES: The OMB will consider all written comments that agency receives on or before March 24, 2016. 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 free of charge from the RegInfo.gov Web site at https:// www.reginfo.gov/public/do/ PRAViewICR?ref_nbr=201601-1240-006 or by contacting Michel Smyth by telephone at 202–693–4129, TTY 202– 693–8064, (these are not toll-free numbers) or by email at DOL_PRA_ PUBLIC@dol.gov. Submit comments about this request by mail or courier 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; by Fax: 202–395–5806 (this is not a toll-free number); or by email: OIRA_ submission@omb.eop.gov. Commenters are encouraged, but not required, to send a courtesy copy of any comments by mail or courier to the U.S. Department of Labor-OASAM, Office of the Chief Information Officer, Attn: Departmental Information Compliance Management Program, Room N1301, 200 Constitution Avenue NW., Washington, DC 20210; or by email: DOL_PRA_PUBLIC@dol.gov. FOR FURTHER INFORMATION CONTACT: Michel Smyth by telephone at 202–693– 4129, TTY 202–693–8064, (these are not toll-free numbers) or by email at DOL_ PRA_PUBLIC@dol.gov. SUPPLEMENTARY INFORMATION: This ICR seeks to extend PRA authority for the Claim for Medical Reimbursement Form mstockstill on DSK4VPTVN1PROD with NOTICES SUMMARY: VerDate Sep<11>2014 17:06 Feb 22, 2016 Jkt 238001 information collection. Form OWCP– 915 is used to claim reimbursement for out-of-pocket covered medical expenses paid by a beneficiary and must be accompanied by required billing data elements (prepared by the medical provider) and by proof of payment by the beneficiary. Federal Employees Compensation Act section 9, Black Lung Benefits Act section 413, and Energy Employees Occupational Illness Compensation Program Act of 2000 section 3629(c), authorize this information collection. See 5 U.S.C. 8103, 30 U.S.C. 936, and 42 U.S.C. 7384t. 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 that 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 1240–0007. OMB authorization for an ICR cannot be for more than three (3) years without renewal, and the DOL seeks to extend PRA authorization for this information collection for three (3) more years, without any change to existing requirements. The DOL notes that existing information collection requirements submitted to the OMB receive a month-to-month extension while they undergo review. For additional substantive information about this ICR, see the related notice published in the Federal Register on August 17, 2015 (80 FR 49279). 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 thirty (30) days of publication of this notice in the Federal Register. In order to help ensure appropriate consideration, comments should mention OMB Control Number 1240–0007. 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, PO 00000 Frm 00100 Fmt 4703 Sfmt 4703 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: Claim for Medical Reimbursement Form. OMB Control Number: 1240–0007. Affected Public: Individuals or Households. Total Estimated Number of Respondents: 10,632. Total Estimated Number of Responses: 38,480. Total Estimated Annual Time Burden: 6,388 hours. Total Estimated Annual Other Costs Burden: $68,879. Authority: 44 U.S.C. 3507(a)(1)(D). Dated: February 12, 2016. Michel Smyth, Departmental Clearance Officer. [FR Doc. 2016–03761 Filed 2–22–16; 8:45 am] BILLING CODE 4510–CRX–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) titled, ‘‘Uniform Billing Form,’’ to the Office of Management and Budget (OMB) for review and approval for continued use, without change, in accordance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C. 3501 et seq.). Public comments on the ICR are invited. DATES: The OMB will consider all written comments that agency receives on or before March 24, 2016. 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 free of charge from the SUMMARY: E:\FR\FM\23FEN1.SGM 23FEN1 Federal Register / Vol. 81, No. 35 / Tuesday, February 23, 2016 / Notices RegInfo.gov Web site at https:// www.reginfo.gov/public/do/ PRAViewICR?ref_nbr=201601-1240-008 or by contacting Michel Smyth by telephone at 202–693–4129, TTY 202– 693–8064, (these are not toll-free numbers) or sending an email to DOL_ PRA_PUBLIC@dol.gov. Submit comments about this request by mail or courier 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; by Fax: 202–395–5806 (this is not a toll-free number); or by email: OIRA_ submission@omb.eop.gov. Commenters are encouraged, but not required, to send a courtesy copy of any comments by mail or courier to the U.S. Department of Labor-OASAM, Office of the Chief Information Officer, Attn: Departmental Information Compliance Management Program, Room N1301, 200 Constitution Avenue NW., Washington, DC 20210; or by email: DOL_PRA_PUBLIC@dol.gov. FOR FURTHER INFORMATION CONTACT: Michel Smyth by telephone at 202–693– 4129, TTY 202–693–8064, (these are not toll-free numbers) or sending an email to DOL_PRA_PUBLIC@dol.gov. Authority: 44 U.S.C. 3507(a)(1)(D). This ICR seeks to extend PRA authority for the Uniform Billing Form information collection. The OWCP requires an institutional medical provider that provides services to a beneficiary covered under the Federal Employees’ Compensation Act (FECA), Black Lung Benefits Act (BLBA), or Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA) to bill using Form OWCP–04 that is based on the industry standard, Form UB–04. The form identifies the beneficiary, the type of services provided, the treated conditions, and the amounts billed. The OWCP requires this information to enable the agency to pay the provider for covered services. FECA section 9, BLBA section 413, and EEOICPA section 3629(c) authorize this information collection. See 5 U.S.C. 8103, 30 U.S.C. 936, and 42 U.S.C. 7384t. 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 mstockstill on DSK4VPTVN1PROD with NOTICES SUPPLEMENTARY INFORMATION: VerDate Sep<11>2014 17:06 Feb 22, 2016 Jkt 238001 law, no person shall generally be subject to penalty for failing to comply with a collection of information that 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. OMB authorization for an ICR cannot be for more than three (3) years without renewal, and the DOL seeks to extend PRA authorization for this information collection for three (3) more years, without any change to existing requirements. The DOL notes that existing information collection requirements submitted to the OMB receive a month-to-month extension while they undergo review. For additional substantive information about this ICR, see the related notice published in the Federal Register on July 23, 2015 (80 FR 43800). 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 thirty (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 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: 6,277. Total Estimated Number of Responses: 221,992. PO 00000 Frm 00101 Fmt 4703 Sfmt 4703 8995 Total Estimated Annual Time Burden: 25,503 hours. Total Estimated Annual Other Costs Burden: $0. Dated: February 12, 2016. Michel Smyth, Departmental Clearance Officer. [FR Doc. 2016–03736 Filed 2–22–16; 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; Workforce Investment Act Adult and Dislocated Worker Programs Gold Standard Evaluation ACTION: Notice. The Department of Labor (DOL) is submitting the Employment and Training Administration (ETA) sponsored information collection request (ICR) revision titled, ‘‘Workforce Investment Act Adult and Dislocated Worker Programs Gold Standard Evaluation,’’ to the Office of Management and Budget (OMB) for review and approval for use in accordance with the Paperwork Reduction Act of 1995 (PRA), 44 U.S.C. 3501 et seq. Public comments on the ICR are invited. DATES: The OMB will consider all written comments that agency receives on or before March 24, 2016. 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 free of charge from the RegInfo.gov Web site at https:// www.reginfo.gov/public/do/ PRAViewICR?ref_nbr=201511–1205–003 (this link will only become active on the day following publication of this notice) or by contacting Michel Smyth by telephone at 202–693–4129, TTY 202– 693–8064, (these are not toll-free numbers) or by email at DOL_PRA_ PUBLIC@dol.gov. Submit comments about this request by mail or courier to the Office of Information and Regulatory Affairs, Attn: OMB Desk Officer for DOL–ETA, Office of Management and Budget, Room 10235, 725 17th Street NW., Washington, DC 20503; by Fax: 202– 395–5806 (this is not a toll-free number); or by email: OIRA_ submission@omb.eop.gov. Commenters are encouraged, but not required, to send a courtesy copy of any comments SUMMARY: E:\FR\FM\23FEN1.SGM 23FEN1

Agencies

[Federal Register Volume 81, Number 35 (Tuesday, February 23, 2016)]
[Notices]
[Pages 8994-8995]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-03736]

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DEPARTMENT OF LABOR

Office of the Secretary

Agency Information Collection Activities; Submission for OMB
Review; Comment Request; Uniform Billing Form

ACTION: Notice.

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SUMMARY: The Department of Labor (DOL) is submitting the Office of
Workers' Compensation Programs (OWCP) sponsored information collection
request (ICR) titled, ``Uniform Billing Form,'' to the Office of
Management and Budget (OMB) for review and approval for continued use,
without change, in accordance with the Paperwork Reduction Act (PRA) of
1995 (44 U.S.C. 3501 et seq.). Public comments on the ICR are invited.

DATES: The OMB will consider all written comments that agency receives
on or before March 24, 2016.

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 free of charge
from the

[[Page 8995]]

RegInfo.gov Web site at https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=201601-1240-008 or by contacting Michel Smyth by
telephone at 202-693-4129, TTY 202-693-8064, (these are not toll-free
numbers) or sending an email to DOL_PRA_PUBLIC@dol.gov.
Submit comments about this request by mail or courier 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; by Fax: 202-395-5806 (this is not a toll-free
number); or by email: OIRA_submission@omb.eop.gov. Commenters are
encouraged, but not required, to send a courtesy copy of any comments
by mail or courier to the U.S. Department of Labor-OASAM, Office of the
Chief Information Officer, Attn: Departmental Information Compliance
Management Program, Room N1301, 200 Constitution Avenue NW.,
Washington, DC 20210; or by email: DOL_PRA_PUBLIC@dol.gov.

FOR FURTHER INFORMATION CONTACT: Michel Smyth by telephone at 202-693-
4129, TTY 202-693-8064, (these are not toll-free numbers) or sending an
email to DOL_PRA_PUBLIC@dol.gov.

Authority: 44 U.S.C. 3507(a)(1)(D).

SUPPLEMENTARY INFORMATION: This ICR seeks to extend PRA authority for
the Uniform Billing Form information collection. The OWCP requires an
institutional medical provider that provides services to a beneficiary
covered under the Federal Employees' Compensation Act (FECA), Black
Lung Benefits Act (BLBA), or Energy Employees Occupational Illness
Compensation Program Act of 2000 (EEOICPA) to bill using Form OWCP-04
that is based on the industry standard, Form UB-04. The form identifies
the beneficiary, the type of services provided, the treated conditions,
and the amounts billed. The OWCP requires this information to enable
the agency to pay the provider for covered services. FECA section 9,
BLBA section 413, and EEOICPA section 3629(c) authorize this
information collection. See 5 U.S.C. 8103, 30 U.S.C. 936, and 42 U.S.C.
7384t.
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 that
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.
OMB authorization for an ICR cannot be for more than three (3)
years without renewal, and the DOL seeks to extend PRA authorization
for this information collection for three (3) more years, without any
change to existing requirements. The DOL notes that existing
information collection requirements submitted to the OMB receive a
month-to-month extension while they undergo review. For additional
substantive information about this ICR, see the related notice
published in the Federal Register on July 23, 2015 (80 FR 43800).
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 thirty (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 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: 6,277.
Total Estimated Number of Responses: 221,992.
Total Estimated Annual Time Burden: 25,503 hours.
Total Estimated Annual Other Costs Burden: $0.

Dated: February 12, 2016.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2016-03736 Filed 2-22-16; 8:45 am]
BILLING CODE 4510-CR-P

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