[Federal Register Volume 62, Number 147 (Thursday, July 31, 1997)]
[Notices]
[Pages 41084-41085]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-20101]


-----------------------------------------------------------------------

DEPARTMENT OF LABOR

Employment Standards Administration


Proposed Collection; Comment Request

ACTION: Notice.

-----------------------------------------------------------------------

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

[[Page 41085]]

Employment Standards Administration is soliciting comments concerning a 
proposed extension information collection, the Uniform Health Insurance 
Claim Form.
    Copies of the proposed information collection requests can be 
obtained by contacting the office listed below in the addressee section 
of this notice.

DATES: Written comments must be submitted to the office listed in the 
addressee section below on or before September 30, 1997. 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.

ADDRESSES: Ms. Margaret Sherrill, U.S. Department of Labor, 200 
Constitution Ave., NW., Room S-3201, Washington, DC 20210, telephone 
(202) 219-7601. (This is not a toll-free number.) Fax 202-219-6592.

SUPPLEMENTARY INFORMATION:

I. Background

    The Office of Workers' Compensation has responsibility for 
administering the Federal Employees' Compensation Act (FECA--5 USC 8101 
et. seq.) and the Federal Black Lung Benefits Act (FBLBA) provisions of 
the Federal Mine Safety and Health Act (30 USC 901 et. seq.). These 
statutes provide for payment to medical institutions for certain 
medical treatment and diagnostic services for employment-related 
injuries and illnesses. To determine appropriate payment of medical 
bills submitted by such provider(s), both FECA and FBLA programs 
require the billing institution(s) to identify the claimant/beneficiary 
and to specify (1) the type of injury/illness being treated, (2) the 
need for the medical services rendered, (3) the specific procedure(s) 
performed, and (4) the relationship to the accepted industrial injury/
illness for FECA claimants and to coal mine workers' pneumoconiosis for 
Black Lung claimants.

II. Current Actions

    The Department of Labor (DOL) seeks extension of approval to 
collect this information to carry out its responsibility to insure that 
providers of medical services to FECA and BLBA beneficiaries receive 
appropriate payment for injuries and illnesses covered under the Acts. 
Failure to request this information will prohibit the Department's 
ability to fulfill this mandate.
    Type of Review: Extension.
    Agency: Employment Standards Administration.
    Title: Uniform Health Insurance Claim Form.
    OMB Number: 1215-0176.
    Agency Numbers: UB-92.
    Affected Public: Individuals or households, State or local 
governments, Businesses or other for profit, Federal agencies or 
employees, Not-for-profit institutions, Small businesses or 
organizations.
    Total Repondents: 138,382.
    Frequency: On occasion.
    Total Responses: 138,382.
    Average Time Per Response:

UB-92 FECA--17 minutes
UB-92 FBLBA--7 minutes
EOB FECA--7 minutes

    Estimated Total Burden Hours: 31,889.
    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 requests; they will also become 
a matter of public record.

    Dated: July 24, 1997.
Margaret J. Sherrill,
Management Analysis Officer, Division Financial Management, Office of 
Management, Administration and Planning, Employment Standards 
Administration.
[FR Doc. 97-20101 Filed 7-30-97; 8:45 am]
BILLING CODE 4510-27-M