[Federal Register Volume 86, Number 220 (Thursday, November 18, 2021)]
[Notices]
[Pages 64529-64530]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-25163]


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DEPARTMENT OF LABOR

Office of Workers' Compensation Programs


Agency Information Collection Activities; Comment Request; 
Uniform Billing Form

ACTION: Notice.

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AGENCY: Office of Workers' Compensation Programs.
SUMMARY: The Department of Labor (DOL) is soliciting comments 
concerning a proposed extension for the authority to conduct the 
information collection request (ICR) titled, ``Uniform Billing Form''. 
This comment request is part of continuing Departmental efforts to 
reduce paperwork and respondent burden in accordance with the

[[Page 64530]]

Paperwork Reduction Act of 1995 (PRA).

DATES: Consideration will be given to all written comments received by 
January 18, 2022.

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 for free by 
contacting Anjanette Suggs by telephone at 202-354-9660 or by email at 
[email protected].
    Submit written comments about this ICR by mail or courier to the 
U.S. Department of Labor, Office of Workers' Compensation Programs, 
Room S3323, 200 Constitution Avenue NW, Washington, DC 20210; or by 
email at [email protected]. Please note that comments submitted 
after the comment period will not be considered.

FOR FURTHER INFORMATION CONTACT: Anjanette Suggs by telephone at 202-
354-9660 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 Office of Management and 
Budget (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.
    The Office of Workers' Compensation Programs (OWCP) is the agency 
responsible for administration of the Federal Employees' Compensation 
Act, 5 U.S.C. 8101 et seq., the Black Lung Benefits Act, 30 U.S.C. 901 
et seq., and the Energy Employees Occupational Illness Compensation 
Program Act of 2000, 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 by various other government health care providers, and the 
private sector, to request payment to institutional providers of 
medical services. The paper UB-04 form 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 form 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 March 31, 2022.
    Interested parties are encouraged to provide comments to the 
contact shown in the ADDRESSES section. Written comments will receive 
consideration, and be summarized and included in the request for OMB 
approval of the final ICR. In order to help ensure appropriate 
consideration, comments should mention OMB No. 1240-0019.
    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: Revision of currently approved collection.
    Title of Collection: Uniform Billing Form.
    Form: OWCP-04, Uniform Billing Form.
    OMB Control Number: 1240-0019.
    Affected Public: Private Sector: Business or other for-profit 
institutions; not for-profit.
    Estimated Number of Respondents: 6,077.
    Frequency: On occasion.
    Total Estimated Annual Responses: 190,970.
    Estimated Average Time per Response: 1-7 minutes.
    Estimated Total Annual Burden Hours: 29,466.
    Total Federal Cost: $1,981,286.
    Total Estimated Annual Other Cost Burden: 0.

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

Anjanette Suggs,
Agency Clearance Officer.
[FR Doc. 2021-25163 Filed 11-17-21; 8:45 am]
BILLING CODE 4510-CH-P