[Federal Register Volume 77, Number 166 (Monday, August 27, 2012)]
[Notices]
[Page 51830]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-20958]



[[Page 51830]]

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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Proposed Extension of Existing Collection; Comment Request

ACTION: Notice.

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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 Office of Workers' Compensation Programs is soliciting 
comments concerning the proposed extension of the existing collection: 
Uniform Billing Form (OWCP-04). A copy of the proposed information 
collection request can be obtained by contacting the office listed 
below in the addresses section of this Notice.

DATES: Written comments must be submitted to the office listed in the 
addresses section below on or before October 26, 2012.

ADDRESSES: Ms Yoon Ferguson, U.S. Department of Labor, 200 Constitution 
Ave. NW., Room S-3201, Washington, DC 20210, telephone (202) 693-0701, 
fax (202) 693-2447, Email [email protected]. Please use only one 
method of transmission for comments (mail, fax, or Email).

SUPPLEMENTARY INFORMATION:

I. Background

    The Office of Workers' Compensation Programs (OWCP) is the agency 
responsible for administration of 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. All 
three of these statutes require that OWCP pay for medical treatment of 
beneficiaries; this medical treatment can include inpatient/outpatient 
hospital services, as well as services provided by nursing homes, 
skilled nursing facilities and home health aides in the home. In order 
to determine whether billed amounts are appropriate, OWCP needs to 
identify the patient, the specific services that were rendered and 
their relationship to the work-related injury or illness. The 
regulations implementing these statutes require the use of Form OWCP-04 
or UB-04 for the submission of medical bills from institutional 
providers (20 CFR 10.801, 30.701, 725.405, 725.406, 725.701 and 
725.704). The Uniform Billing form, known as the paper UB-04, has been 
approved by the American Hospital Association, the Centers for Medicare 
and Medicaid Services and the Civilian Health and Medical Program of 
Uniformed Services (CHAMPUS), by various other government health care 
providers, and the private sector to request payment to institutional 
providers of medical services. The paper UB-04 has been designed by the 
National Uniform Billing Committee and is neither a government-printed 
form nor distributed by OWCP. However, this collection includes the 
paper UB-04 as a collection instrument, with detailed instructions 
prepared by OWCP to ensure that it obtains only the information needed 
to consider requests for payment from institutional providers using 
this billing form. This information collection is currently approved 
for use through November 30, 2012.

II. Review Focus

    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.

III. Current Actions

    The Department of Labor seeks the approval of the extension of this 
currently approved information collection in order to carry out its 
responsibility to provide payment for covered medical services to 
beneficiaries who are covered under FECA, BLBA and EEOICPA.
    Type of Review: Extension
    Agency: Office of Workers' Compensation Programs
    Title: Uniform Billing Form
    OMB Number: 1240-0019
    Agency Number: OWCP-04
    Affected Public: Individuals or households; Businesses or other 
for-profit; Not-for-profit institutions
    Total Respondents: 6,947
    Total Responses: 230,997
    Time per Response: 1-7 minutes
    Estimated Total Burden Hours: 26,599
    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 request; they will also become a 
matter of public record.

    Dated: August 21, 2012.
Yoon Ferguson,
Agency Clearance Officer, Office of Workers' Compensation Programs, 
U.S. Department of Labor.
[FR Doc. 2012-20958 Filed 8-24-12; 8:45 am]
BILLING CODE 4510-CR-P