[Federal Register Volume 86, Number 25 (Tuesday, February 9, 2021)]
[Notices]
[Pages 8806-8807]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-02634]


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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Agency Information Collection Activities; Comment Request; Claim 
for Medical Reimbursement Form

ACTION: Notice of availability; request for comments.

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SUMMARY: The Department of Labor (DOL) is soliciting comments 
concerning a proposed extension for the authority to conduct the 
information collection request (ICR) titled, ``Claim for Medical 
Reimbursement Form.'' This comment request is part of continuing 
Departmental efforts to reduce paperwork and respondent burden in

[[Page 8807]]

accordance with the Paperwork Reduction Act of 1995 (PRA).

DATES: Consideration will be given to all written comments received by 
April 12, 2021.

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 by 
contacting Anjanette Suggs by telephone at (202) 354-9660 (this is not 
toll-free number) or by email at [email protected].
    Submit written comments about, or requests for a copy of, this ICR 
by mail or courier to the U.S. Department of Labor, Office of Workers' 
Compensation Programs, Room N1301, 200 Constitution Avenue NW, 
Washington, DC 20210; by email: [email protected].

FOR FURTHER INFORMATION CONTACT: Contact Anjanette Suggs by telephone 
at (202) 354-9660 (this is not a toll-free number) or by email at 
[email protected].

SUPPLEMENTARY INFORMATION: The DOL, as part of continuing efforts to 
reduce paperwork and respondent burden, conducts a pre-clearance 
consultation program to provide the general public and Federal agencies 
an opportunity to comment on proposed and/or continuing collections of 
information before submitting them to the OMB for final approval. This 
program helps to ensure 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 can be properly assessed.
    Form OWCP-915 is used to claim reimbursement for out-of-pocket 
covered medical expenses paid by a beneficiary, and must be accompanied 
by required billing data elements (prepared by the medical provider) 
and by proof of payment by the beneficiary. Employees Compensation Act, 
5 U.S.C. 8101, Black Lung Benefits Act, 30 U.S.C. 901, Energy Employees 
Occupational Illness Compensation Program Act of 2000, 42 U.S.C. 7384 
authorize this information collection.
    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.
    Interested parties are encouraged to provide comments to the 
contact shown in the ADDRESSES section. Comments must be written to 
receive consideration, and they will be summarized and included in the 
request for OMB approval of the final ICR. In order to help ensure 
appropriate consideration, comments should mention 1240-0007.
    Submitted comments will also be a matter of public record for this 
ICR and posted on the internet, without redaction. The DOL encourages 
commenters not to include personally identifiable information, 
confidential business data, or other sensitive statements/information 
in any comments.
    The DOL 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.
    Type of Review: Extension
    Title of Collection: Claim for Medical Reimbursement Form.
    Form: OWCP-915.
    OMB Control Number: 1240-0007.
    Affected Public: Individuals or households.
    Estimated Number of Respondents: 10,260.
    Frequency: Annually.
    Total Estimated Annual Responses: 34,564.
    Estimated Average Time per Response: 10 minutes.
    Estimated Total Annual Burden Hours: 5,738 hours.
    Total Estimated Annual Other Cost Burden: $59,450.

    Authority: 44 U.S.C. 3506(c)(2)(A).

Anjanette Suggs,
Agency Clearance Officer.
[FR Doc. 2021-02634 Filed 2-8-21; 8:45 am]
BILLING CODE 4510-CR-P