Labor Department Seeks Public Comment on Info Collection: Health Insurance Claim Form

WASHINGTON, May 3 -- The U.S. Department of Labor has proposed a 30-day public comment period on an information collection entitled: "Health Insurance Claim Form."

A notice was published in the Federal Register by Mara Blumenthal, Senior PRA Analyst.

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 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

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Complete text: https://www.federalregister.gov/documents/2021/05/03/2021-09210/agency-information-collection-activities-submission-for-omb-review-comment-request-health-insurance

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