[Federal Register Volume 86, Number 83 (Monday, May 3, 2021)]
[Notices]
[Pages 23428-23429]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-09210]


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DEPARTMENT OF LABOR


Agency Information Collection Activities; Submission for OMB 
Review; Comment Request; Health Insurance Claim Form

AGENCY: Department of Labor.

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 June 2, 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-1500 is used by OWCP and 
contractor bill payment staff to process bills for medical services 
provided by medical professionals other than medical services provided 
by hospitals, pharmacies and certain other medical providers. This 
information is required to pay health care providers for services 
rendered to injured employees covered under the Office of Workers' 
Compensation Programs--administered programs. Appropriate payment 
cannot be made without documentation of the medical services that were 
provided by the health care provider that is billing OWCP. The 
information obtained to complete claims under these programs is used to 
identify the patient and determine their eligibility. It is also used 
to decide if the services and supplies received are covered by these 
programs and to assure that proper payment is made. Energy Employees 
Occupational Illness Compensation Program Act of 2000, 42 U.S.C., Black 
Lung Benefits Act, 30 U.S.C. 901, and the Federal Employees 
Compensation Act, 5 U.S.C. 8101 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 
8804).
    This information collection is subject to the PRA. A Federal agency 
generally cannot conduct or sponsor a collection

[[Page 23429]]

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: Health Insurance Claim Form.
    OMB Control Number: 1240-0044.
    Affected Public: Private Sector--Businesses or other for-profits.
    Total Estimated Number of Respondents: 57,099.
    Total Estimated Number of Responses: 3,381,232.
    Total Estimated Annual Time Burden: 394,477 hours.
    Total Estimated Annual Other Costs Burden: $0.

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

     Dated: April 23, 2021.
Mara Blumenthal,
Senior PRA Analyst.
[FR Doc. 2021-09210 Filed 4-30-21; 8:45 am]
BILLING CODE 4510-CR-P