[Federal Register Volume 68, Number 192 (Friday, October 3, 2003)]
[Notices]
[Pages 57488-57489]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-25109]


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DEPARTMENT OF LABOR

Office of the Secretary


Submission for OMB Review; Comment Request

September 17, 2003.
    The Department of Labor (DOL) has submitted the following public 
information collection requests (ICRs) to the Office of Management and 
Budget (OMB) for review and approval in accordance with the Paperwork 
Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. chapter 35). A copy of 
each ICR, with applicable supporting documentation, may be obtained by 
calling the Department of Labor. To obtain documentation, contact 
Darrin King on 202-693-4129 (this is not a toll-free number) or e-mail: 
[email protected].
    Comments should be sent to Office of Information and Regulatory 
Affairs, Attn: OMB Desk Officer for the Employment Standards 
Administration (ESA), Office of Management and Budget, Room 10235, 
Washington, DC 20503 (202-395-7316/this is not a toll-free number), 
within 30 days from the date of this publication in the Federal 
Register.
    The OMB is particularly interested in comments which:
    [sbull] 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;
    [sbull] 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;
    [sbull] Enhance the quality, utility, and clarity of the 
information to be collected; and
    [sbull] 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.
    Type of Review: Extension of a currently approved collection.
    Agency: Employment Standards Administration.
    Title: Health Insurance Claim Form.
    OMB Number: 1215-0055.
    Affected Public: Business or other for-profit; Not-for-profit 
institutions; and Individuals or households.
    Frequency: On occasion.
    Number of Respondents: 533,427.
    Number of Annual Responses: 2,133,708.
    Estimated Time Per Response: 7 minutes.
    Total Burden Hours: 248,812.
    Total Annualized Capital/Startup Costs: $0.
    Total Annual Costs (operating/maintaining systems or purchasing 
services): $0.
    Description: The information collected by the Form OWCP-1500 is 
required to reimburse health care providers for services rendered to 
injured employees covered under the Federal Employees' Compensation 
Act, 5 U.S.C. 8101 et seq., the Black Lung Benefits Act, 30 U.S.C. 901 
et seq., and the Energy Employees Occupational Illness Compensation 
Program Act of 2000 42 U.S.C. 7384 et seq. Appropriate reimbursement 
cannot be made without documentation that details services provided by 
health care professionals throughout the country.

    Type of Review: Extension of a currently approved collection.
    Agency: Employment Standards Agency.
    Title: Authorization for Release of Medical Information.
    OMB Number: 1215-0057.
    Affected Public: Individuals or households.
    Frequency: One time.
    Number of Respondents: 1,500.
    Number of Annual Responses: 1,500.
    Estimated Time Per Response: 5 minutes.
    Total Burden Hours: 125.
    Total Annualized Capital/Startup Costs: $0.
    Total Annual Costs (operating/maintaining systems or purchasing 
services): $0.

[[Page 57489]]

    Description: The Black Lung Benefits Act, as amended, 30 U.S.C. 901 
et seq., and 20 CFR 725.405 require that all relevant medical evidence 
be considered before a decision can be made regarding a claimant's 
eligibility for benefits. The CM-936 is a form that gives the 
claimant's consent for release of information required by the Privacy 
Act of 1974, and contains information required by medical institutions 
and private physicians to enable them to release pertinent medical 
information.

Ira L. Mills,
Department Clearance Officer.
[FR Doc. 03-25109 Filed 10-2-03; 8:45 am]
BILLING CODE 4510-23-M