[Federal Register Volume 71, Number 249 (Thursday, December 28, 2006)]
[Notices]
[Page 78224]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-22238]



[[Page 78224]]

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DEPARTMENT OF LABOR

Office of the Secretary


Submission for OMB Review: Comment Request

December 21, 2006.
    The Department of Labor (DOL) has submitted the following public 
information collection requests (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 
each ICR, with applicable supporting documentation, may be obtained 
from RegInfo.gov at http://www.reginfo.gov/public/do/PRAMain or by 
contacting Darrin King on 202-693-4129 (this is not a toll-free number) 
/ 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, Telephone: 202-395-7316 / Fax: 202-395-6974 
(these are not a toll-free numbers), within 30 days from the date of 
this publication in the Federal Register.
    The OMB 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 submission of responses.
    Agency: Employment Standards Administration.
    Type of Review: Extension without change of currently approved 
collection.
    Title: Request for Employment Information.
    OMB Number: 1215-0105.
    Frequency: On occasion.
    Type of Response: Reporting.
    Affected Public: Private Sector: Business and other for-profit.
    Estimated Number of Respondents: 500.
    Estimated Number of Annual Responses: 500.
    Estimated Average Response Time: 15 minutes.
    Estimated Total Annual Burden Hours: 125.
    Total Annualized capital/startup costs: $0.
    Total Annual Costs (operating/maintaining systems or purchasing 
services): $210.
    Description: This information collection is used to collect 
information about a claimant's employment. It is necessary to determine 
continued eligibility for compensation payments under the Federal 
Employees' Compensation Act (5 U.S.C. 8106).
    Agency: Employment Standards Administration.
    Type of Review: Extension without change of currently approved 
collection.
    Title: Claim for Medical Reimbursement Form.
    OMB Number: 1215-0193.
    Frequency: On occasion and Annually.
    Type of Response: Reporting.
    Affected Public: Individuals or households.
    Estimated Number of Respondents: 21,396.
    Estimated Number of Annual Responses: 85,584.
    Estimated Average Response Time: 10 minutes.
    Estimated Total Annual Burden Hours: 14,207.
    Total Annualized capital/startup costs: $0.
    Total Annual Costs (operating/maintaining systems or purchasing 
services): $103,557.
    Description: The Office of Workers' Compensation Programs (OWCP) 
administers 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. All three statutes require OWCP to pay for 
covered medical treatment that is provided to beneficiaries, and also 
to reimburse beneficiaries for any out-of-pocket covered medical 
expenses they have paid. Form OWCP-915, Claim for Medical Reimbursement 
Form, is used for this purpose and collects the necessary beneficiary 
and medical provider data in a standard format. Beneficiaries must also 
attach billing information prepared by the medical provider (Form OWCP-
1500 for professional medical services, Form OWCP-92 for institutional 
providers and hospitals, or a paper bill for prescription drugs 
dispensed by a pharmacy) and proof of payment.

Darrin A. King,
Acting Departmental Clearance Officer.
 [FR Doc. E6-22238 Filed 12-27-06; 8:45 am]
BILLING CODE 4510-CH-P