This PDF is the current document as it appeared on Public Inspection on 11/26/2012 at 08:45 am.
The Department of Labor (DOL) is submitting the Office of Workers' Compensation Programs (OWCP) sponsored information collection request (ICR) revision titled, “Uniform Billing Form,” (Form OWCP-04) to the Office of Management and Budget (OMB) for review and approval for use in accordance with the Paperwork Reduction Act (PRA) of 1995.
Submit comments on or before December 27, 2012.
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 from the RegInfo.gov Web site, http://www.reginfo.gov/public/do/PRAMain, on the day following publication of this notice or by contacting Michel Smyth by telephone at 202-693-4129 (this is not a toll-free number) or sending an email to DOL_PRA_PUBLIC@dol.gov.
Submit comments about this request 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, Fax: 202-395-6881 (this is not a toll-free number), email: OIRA_submission@omb.eop.gov.
FOR FURTHER INFORMATION CONTACT:
Michel Smyth by telephone at 202-693-4129 (this is not a toll-free number) or by email at DOL_PRA_PUBLIC@dol.gov.
The OWCP requires an institutional medical provider providing any services to a beneficiary covered under the Federal Employee's Compensation Act, Black Lung Benefits Act, or Energy Employees Occupational Illness Compensation Program Act of 2000 to bill using a form based on the industry standard, Form UB-04. Form OWCP-04 identifies the beneficiary, the type of services provided, the conditions being treated, and the billed amounts. This information enables the OWCP to pay providers for covered services.
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 if the collection of information 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 1240-0019. The current approval is scheduled to expire on November 30, 2012; however, it should be noted that existing information collection requirements submitted to the OMB receive a month-to-month extension while they undergo review. For additional information, see the related notice published in the Federal Register on August 27, 2012 (77 FR 51830).
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 30 days of publication of this notice in the Federal Register. In order to help ensure appropriate consideration, comments should mention OMB Control Number 1240-0019. 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.
Title of Collection: Uniform Billing Form.
OMB Control Number: 1240-0019.
Affected Public: Private Sector—businesses or other for-profits and not-for-profit institutions.
Total Estimated Number of Respondents: 6,947.
Total Estimated Number of Responses: 229,997.
Total Estimated Annual Burden Hours: 26,599.
Total Estimated Annual Other Costs Burden: $0.
Dated: November 19, 2012.
Departmental Clearance Officer.
[FR Doc. 2012-28658 Filed 11-26-12; 8:45 am]
BILLING CODE 4510-CR-P