[Federal Register Volume 77, Number 243 (Tuesday, December 18, 2012)]
[Notices]
[Pages 74881-74882]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-30401]


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DEPARTMENT OF LABOR

Office of the Secretary


Agency Information Collection Activities; Submission for OMB 
Review; Comment Request; Claim for Medical Reimbursement

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, ``Claim for Medical Reimbursement,'' to 
the Office of Management and Budget (OMB) for review and approval for 
use in accordance with the Paperwork Reduction Act (PRA) of 1995 (44 
U.S.C. 3501 et seq.).

DATES: Submit comments on or before January 17, 2013.

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: Beneficiaries file a Claim for Medical 
Reimbursement, Form OWCP-915, to obtain reimbursement for out-of-pocket 
covered medical expenses paid by a beneficiary. Required billing data 
elements (prepared by the medical provider) and proof of payment by the 
beneficiary must accompany the claims form. While not expected to 
change respondent burden, this ICR has been characterized as a revision 
because the agency has reformatted elements of Form OWCP-915 (e.g., 
replaced an obsolete logo with the DOL Seal, provided an additional 
notice on the rights of respondents with disabilities, and removed 
references to the no longer existent Employment Standards 
Administration).
    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 that 
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 1240-0007. The current approval is scheduled to 
expire on December 31, 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 September 17, 2012 (77 FR 57161).
    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 1240-0007. 
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: Claim for Medical Reimbursement.
    OMB Control Number: 1240-0007.

[[Page 74882]]

    Affected Public: Individuals or Households.
    Total Estimated Number of Respondents: 8,309.
    Total Estimated Number of Responses: 24,872.
    Total Estimated Annual Burden Hours: 4,294.
    Total Estimated Annual Other Costs Burden: $42,689.

    Dated: December 11, 2012.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2012-30401 Filed 12-17-12; 8:45 am]
BILLING CODE 4510-CR-P