[Federal Register Volume 74, Number 162 (Monday, August 24, 2009)]
[Notices]
[Pages 42693-42694]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-20272]


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DEPARTMENT OF LABOR

Office of the Secretary


Submission for OMB Review: Comment Request

August 18, 2009.
    The Department of Labor (DOL) hereby announces the submission of 
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; including among other things a description of the likely 
respondents, proposed frequency of response, and estimated total burden 
may be obtained from the RegInfo.gov website at http://www.reginfo.gov/public/do/PRAMain or by contacting Mary Beth Smith-Toomey on 202-693-
4223 (this is not a toll-free number)/e-mail: [email protected].
    Interested parties are encouraged to send comments to the Office of 
Information and Regulatory Affairs, Attn: OMB Desk Officer for the 
Department of Labor--ESA, Office of Management and Budget, Room 10235, 
Washington, DC 20503, Telephone: 202-395-7316/Fax: 202-395-5806 (these 
are not toll-free numbers), E-mail: [email protected] within 
30 days from the date of this publication in the Federal Register. In 
order to ensure the appropriate consideration, comments should 
reference the OMB Control Number (see below).
    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: Revision of a currently approved collection.
    Title of Collection: Health Insurance Claim Form.
    OMB Control Number: 1215-0055.
    Agency Form Number: OWCP-1500.
    Affected Public: Private Sector, Businesses and other for-profits.
    Total Estimated Number of Respondents: 749,104.
    Total Estimated Annual Burden Hours: 359,359.
    Total Estimated Annual Costs Burden (does not include hour costs): 
$0.
    Description: Form OWCP-1500 is used by OWCP and contractor bill 
payment staff to process bills for medical services provided by medical 
professionals other than medical services provided by hospitals, 
pharmacies and certain other medical providers. OWCP is adding the data 
elements National Provider Identifier (NPI) and taxonomy number, which 
will be 32a and 33a on the revised OWCP-1500. This information is 
required to pay health care providers for services rendered to injured 
employees covered under the Office of Worker's Compensation Programs--
administered programs. Appropriate payment cannot be made without 
documentation of the medical services that were provided by the health 
care provider that is billing OWCP. The information obtained to 
complete claims under these programs is used to identify the patient 
and determine their eligibility. It is also used

[[Page 42694]]

to decide if the services and supplies received are covered by these 
programs and to assure that proper payment is made. For additional 
information, see related notice published at Volume 74 FR 10778 on 
March 12, 2009.
    Agency: Employment Standards Administration.
    Type of Review: Extension without change of a currently approved 
collection.
    Title of Collection: Authorization for Release of Medical 
Information (Black Lung Benefits).
    OMB Control Number: 1215-0057.
    Agency Form Number: CM-936.
    Affected Public: Individuals and households.
    Total Estimated Number of Respondents: 900.
    Total Estimated Annual Burden Hours: 75.
    Total Estimated Annual Costs Burden (does not include hour costs): 
$0.
    Description: The CM-936 is used to obtain the black lung claimant's 
authorization for the Division of Coal Mine Workers' Compensation to 
request medical evidence in support of the black lung claim. For 
additional information, see related notice published at Volume 74 FR 
15005 on April 2, 2009.

Darrin A. King,
Departmental Clearance Officer.
[FR Doc. E9-20272 Filed 8-21-09; 8:45 am]
BILLING CODE 4510-CK-P