[Federal Register Volume 77, Number 228 (Tuesday, November 27, 2012)]
[Notices]
[Pages 70826-70827]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-28658]


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DEPARTMENT OF LABOR

Office of the Secretary


Agency Information Collection Activities; Submission for OMB 
Review; Comment Request; Uniform Billing 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, ``Uniform Billing Form,'' (Form OWCP-04) 
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 27, 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: The OWCP requires an institutional medical 
provider providing any services to a beneficiary covered under the 
Federal Employee's Compensation Act, Black Lung Benefits Act, or Energy 
Employees Occupational Illness Compensation Program Act of 2000 to bill 
using a form based on the industry standard, Form UB-04. Form OWCP-04 
identifies the beneficiary, the type of services provided, the 
conditions being treated, and the billed amounts. This information 
enables the OWCP to pay providers for covered services.
    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 1240-0019. 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 51830).
    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 1240-0019. 
The OMB is particularly interested in comments that:
     Evaluate whether the proposed collection of information is 
necessary

[[Page 70827]]

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: Uniform Billing Form.
    OMB Control Number: 1240-0019.
    Affected Public: Private Sector--businesses or other for-profits 
and not-for-profit institutions.
    Total Estimated Number of Respondents: 6,947.
    Total Estimated Number of Responses: 229,997.
    Total Estimated Annual Burden Hours: 26,599.
    Total Estimated Annual Other Costs Burden: $0.

    Dated: November 19, 2012.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2012-28658 Filed 11-26-12; 8:45 am]
BILLING CODE 4510-CR-P