[Federal Register Volume 80, Number 141 (Thursday, July 23, 2015)]
[Notices]
[Pages 43800-43801]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-18001]


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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.

[[Page 43801]]


DATES: Written comments must be submitted to the office listed in the 
addresses section below on or before September 21, 2015.

ADDRESSES: Ms. Yoon Ferguson, U.S. Department of Labor, 200 
Constitution Ave. NW., Room S-3323, Washington, DC 20210, telephone/fax 
(202) 354-9647, 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 January 31, 2016.
    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: 6,277.
    Total Responses: 221,992.
    Time per Response: 1-7 minutes
    Estimated Total Burden Hours: 25,503.
    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: July 17, 2015.
Yoon Ferguson,
Agency Clearance Officer, Office of Workers' Compensation Programs, US 
Department of Labor.
[FR Doc. 2015-18001 Filed 7-22-15; 8:45 am]
 BILLING CODE 4510-CR-P