[Federal Register Volume 81, Number 37 (Thursday, February 25, 2016)]
[Notices]
[Pages 9513-9514]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-03985]


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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) titled, ``Health Insurance Claim Form,'' to the Office of 
Management and Budget (OMB) for review and approval for continued use, 
without change, in accordance with the Paperwork Reduction Act (PRA) of 
1995

[[Page 9514]]

(44 U.S.C. 3501 et seq.). Public comments on the ICR are invited.

DATES: The OMB will consider all written comments that agency receives 
on or before March 28, 2016.

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 free of charge 
from the RegInfo.gov Web site at http://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=201601-1240-009 or by contacting Michel Smyth by 
telephone at 202-693-4129, TTY 202-693-8064, (these are not toll-free 
numbers) or sending an email to [email protected].
    Submit comments about this request by mail or courier 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; by Fax: 202-395-5806 (this is not a toll-free 
number); or by email: [email protected]. Commenters are 
encouraged, but not required, to send a courtesy copy of any comments 
by mail or courier to the U.S. Department of Labor--OASAM, Office of 
the Chief Information Officer, Attn: Departmental Information 
Compliance Management Program, Room N1301, 200 Constitution Avenue NW., 
Washington, DC 20210; or by email: [email protected].

FOR FURTHER INFORMATION CONTACT: Michel Smyth by telephone at 202-693-
4129, TTY 202-693-8064, (these are not toll-free numbers) or sending an 
email to [email protected].

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

SUPPLEMENTARY INFORMATION: This ICR seeks to extend PRA authority for 
the Health Insurance Claim Form information collection. The OWCP uses 
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, 
because 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. Federal Employees' 
Compensation Act section 9, Black Lung Benefits Act section 413, and 
Energy Employees Occupational Illness Compensation Program Act of 2000 
section 3629(c) authorize this information collection. See 5 U.S.C. 
8103, 30 U.S.C. 936, and 42 U.S.C. 7384t.
    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 1240-0044.
    OMB authorization for an ICR cannot be for more than three (3) 
years without renewal, and the DOL seeks to extend PRA authorization 
for this information collection for three (3) more years, without any 
change to existing requirements. The DOL notes that existing 
information collection requirements submitted to the OMB receive a 
month-to-month extension while they undergo review. For additional 
substantive information about this ICR, see the related notice 
published in the Federal Register on June 16, 2015 (80 FR 34459).
    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 thirty (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: 58,923.
    Total Estimated Number of Responses: 2,777,034.
    Total Estimated Annual Time Burden: 280,856 hours.
    Total Estimated Annual Other Costs Burden: $0.

    Dated: February 18, 2016.
Michel Smyth,
Departmental Clearance Officer.
[FR Doc. 2016-03985 Filed 2-24-16; 8:45 am]
 BILLING CODE 4510-CR-P