[Federal Register Volume 86, Number 77 (Friday, April 23, 2021)]
[Notices]
[Pages 21771-21772]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-08471]


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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 Form

ACTION: Notice of availability; request for comments.

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SUMMARY: The Department of Labor (DOL) is submitting this Office of the 
Workers' Compensation Programs (OWCP)-sponsored information collection 
request (ICR) to the Office of Management and Budget (OMB) for review 
and approval in accordance with the Paperwork Reduction Act of 1995 
(PRA). Public comments on the ICR are invited.

DATES: The OMB will consider all written comments that agency receives 
on or before May 24, 2021.

ADDRESSES: Written comments and recommendations for the proposed 
information collection should be sent within 30 days of publication of 
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular 
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.
    Comments are invited on: (1) Whether the collection of information 
is necessary for the proper performance of the functions of the 
Department, including whether the information will have practical 
utility; (2) if the information will be processed and used in a timely 
manner; (3) the accuracy of the agency's estimates of the burden and 
cost of the collection of information, including the validity of the 
methodology and assumptions used; (4) ways to enhance the quality, 
utility and clarity of the information collection; and (5) ways to 
minimize the burden of the collection of information on those who are 
to respond, including the use of automated collection techniques or 
other forms of information technology.

FOR FURTHER INFORMATION CONTACT: Mara Blumenthal by telephone at 202-
693-8538, or by email at [email protected].

SUPPLEMENTARY INFORMATION: 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. For 
additional substantive information about this ICR, see the related 
notice published in the Federal Register on February 9, 2021 (86 FR 
8806).
    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 the OMB approves it 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 
OMB Control Number. See 5 CFR 1320.5(a) and 1320.6.
    DOL seeks PRA authorization for this information collection for 
three (3) years. OMB authorization for an ICR cannot be for more than 
three (3) years without renewal. The DOL notes that information 
collection requirements submitted to the OMB for existing ICRs receive 
a month-to-month extension while they undergo review.
    Agency: DOL-OWCP.
    Title of Collection: Claim for Medical Reimbursement Form.
    OMB Control Number: 1240-0007.
    Affected Public: Individuals or Households.
    Total Estimated Number of Respondents: 10,260.
    Total Estimated Number of Responses: 34,564.
    Total Estimated Annual Time Burden: 5,738 hours.
    Total Estimated Annual Other Costs Burden: $59,450.


[[Page 21772]]


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

    Dated: April 16, 2021.
Mara Blumenthal,
Senior PRA Analyst.
[FR Doc. 2021-08471 Filed 4-22-21; 8:45 am]
BILLING CODE 4510-CR-P