[Federal Register Volume 68, Number 206 (Friday, October 24, 2003)]
[Notices]
[Page 61014]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-26885]



[[Page 61014]]

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DEPARTMENT OF LABOR

Office of the Secretary


Submission for OMB Review; Comment Request

October 16, 2003.
    The Department of Labor (DOL) has submitted the following public 
information collection request (ICR) 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 
this 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 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.
    Agency: Employment Standards Administration.
    Type of Review: Extension of a currently approved collection.
    Title: Uniform Billing Form.
    OMB Number: 1215-0176.
    Affected Public: Business or other for-profit; Not-for-profit 
institutions; and Individuals or households.
    Frequency: As needed.
    Number of Respondents: 57,679.
    Number of Annual Responses: 230,716.
    Estimated Time Per Response: 7 minutes.
    Total Burden Hours: 26,925.
    Total Annualized Capital/Startup Costs: $0.
    Total Annual Costs (operating/maintaining systems or purchasing 
services): $0.
    Description: The Office of Workers' Compensation Programs (OWCP) 
administers the Federal Employees' Compensation Act (FECA) 5 U.S.C. 
8101 et seq., the Black Lung Benefits Act (BLBA) 30 U.S.C. 901 et seq., 
and the Energy Employees Occupational Illness Compensation Program Act 
of 2000 (EEOICPA), 42 U.S.C. 7384 et seq. These Acts provide, in 
addition to compensation for employment-related injury and/or 
disability, payments to provider institutions for certain non-
professional medical treatment and services related to the injury or 
disability. The Uniform Billing Form (OWCP-92) consists of the industry 
standard billing form (UB-92), which has been approved by the American 
Hospital Association, the Centers for Medicare and Medicaid Services, 
and the Civilian Health and Medical Program of the Uniformed Services, 
by various other government health care programs, and the private 
sector, for the purpose of payment to institutional providers of 
medical services. The OWCP-92 also includes detailed instructions 
developed by OWCP that provide the information necessary to providers 
who file bills for services that may be payable under FECA, BLBA and 
the EEOICPA.

Ira L. Mills,
Departmental Clearance Officer.
[FR Doc. 03-26885 Filed 10-23-03; 8:45 am]
BILLING CODE 4510 CH-M