[Federal Register Volume 77, Number 220 (Wednesday, November 14, 2012)]
[Notices]
[Page 67834]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-27609]


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DEPARTMENT OF LABOR

Office of the Secretary


Agency Information Collection Activities; Submission for OMB 
Review; Comment Request; Health Insurance Claim Form

ACTION: Notice.

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SUMMARY: The Department of Labor (DOL) is submitting the Office of 
Workers' Compensation Programs (OWCP) sponsored information collection 
request (ICR) revision titled, ``Health Insurance Claim Form,'' (Form 
OWCP-1500) to the Office of Management and Budget (OMB) for review and 
approval for use in accordance with the Paperwork Reduction Act (PRA) 
of 1995.

DATES: Submit comments on or before December 14, 2012.

ADDRESSES: A copy of this ICR with applicable supporting documentation; 
including a description of the likely respondents, proposed frequency 
of response, and estimated total burden may be obtained from the 
RegInfo.gov Web site, http://www.reginfo.gov/public/do/PRAMain, on the 
day following publication of this notice or by contacting Michel Smyth 
by telephone at 202-693-4129 (this is not a toll-free number) or 
sending an email to [email protected].
    Submit comments about this request to the Office of Information and 
Regulatory Affairs, Attn: OMB Desk Officer for DOL-OWCP, Office of 
Management and Budget, Room 10235, 725 17th Street NW., Washington, DC 
20503, Fax: 202-395-6881 (this is not a toll-free number), email: 
[email protected].

FOR FURTHER INFORMATION CONTACT: Michel Smyth by telephone at 202-693-
4129 (this is not a toll-free number) or by email at [email protected].

    Authority:  44 U.S.C. 3507(a)(1)(D).

SUPPLEMENTARY INFORMATION: OWCP and contractor bill payment staff use 
Form OWCP-1500 to process bills for medical services provided by 
medical professionals other than medical services provided by 
hospitals, pharmacies, or certain other medical providers. This 
information is required to pay health care providers for services 
rendered to injured employees covered under OWCP-administered programs. 
Appropriate payment cannot be made without documentation of the medical 
services provided by the health care provider billing the OWCP. The 
OWCP uses information obtained to identify the patient and determine 
benefit eligibility. The OWCP also uses the information to decide 
whether services and supplies received are covered by OWCP programs and 
to assure that proper payment is made.
    This information collection is subject to the PRA. A Federal agency 
generally cannot conduct or sponsor a collection of information, and 
the public is generally not required to respond to an information 
collection, unless it is approved by the OMB under the PRA and displays 
a currently valid OMB Control Number. In addition, notwithstanding any 
other provisions of law, no person shall generally be subject to 
penalty for failing to comply with a collection of information if the 
collection of information does not display a valid Control Number. See 
5 CFR 1320.5(a) and 1320.6. The DOL obtains OMB approval for this 
information collection under Control Number 1240-0044. The current 
approval is scheduled to expire on November 30, 2012; however, it 
should be noted that existing information collection requirements 
submitted to the OMB receive a month-to-month extension while they 
undergo review. For additional information, see the related notice 
published in the Federal Register on August 27, 2012 (77 FR 51828).
    Interested parties are encouraged to send comments to the OMB, 
Office of Information and Regulatory Affairs at the address shown in 
the ADDRESSES section within 30 days of publication of this notice in 
the Federal Register. In order to help ensure appropriate 
consideration, comments should mention OMB Control Number 1240-0044. 
The OMB is particularly interested in comments that:
     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: DOL-OWCP.
    Title of Collection: Health Insurance Claim Form.
    OMB Control Number: 1240-0044.
    Affected Public: Private Sector--businesses or other for-profits.
    Total Estimated Number of Respondents: 71,304.
    Total Estimated Number of Responses: 3,036,067.
    Total Estimated Annual Burden Hours: 322,838.
    Total Estimated Annual Other Costs Burden: $0.

    Dated: November 7, 2012.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2012-27609 Filed 11-13-12; 8:45 am]
BILLING CODE 4510-CR-P