Notice2021-25163
Agency Information Collection Activities; Comment Request; Uniform Billing Form
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
November 18, 2021
Issuing agencies
Labor DepartmentWorkers' Compensation Programs Office
Abstract
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 Paperwork Reduction Act of 1995 (PRA).
Full Text
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<title>Federal Register, Volume 86 Issue 220 (Thursday, November 18, 2021)</title>
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[Federal Register Volume 86, Number 220 (Thursday, November 18, 2021)]
[Notices]
[Pages 64529-64530]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[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
<a href="/cdn-cgi/l/email-protection#5221273535217c333c38333c3726263712363d3e7c353d24"><span class="__cf_email__" data-cfemail="8bf8feececf8a5eae5e1eae5eeffffeecbefe4e7a5ece4fd">[email protected]</span></a>.
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 <a href="/cdn-cgi/l/email-protection#d3a0a6b4b4a0fdb2bdb9b2bdb6a7a7b693b7bcbffdb4bca5"><span class="__cf_email__" data-cfemail="c4b7b1a3a3b7eaa5aaaea5aaa1b0b0a184a0aba8eaa3abb2">[email protected]</span></a>. 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 <a href="/cdn-cgi/l/email-protection#6c1f190b0b1f420d02060d02091818092c080300420b031a"><span class="__cf_email__" data-cfemail="bbc8cedcdcc895dad5d1dad5decfcfdefbdfd4d795dcd4cd">[email protected]</span></a>.
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:
<bullet> 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.
<bullet> 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.
<bullet> Enhance the quality, utility, and clarity of the
information to be collected; and
<bullet> 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
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