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###### Department of Labor

###### Office of Workers' Compensation Programs

# ACTION:

Notice of availability; request for comments.

# SUMMARY:

The Department of Labor (DOL) is soliciting comments concerning a proposed extension for the authority to conduct the information collection request (ICR) titled, “Health Insurance Claim 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).

# DATES:

Consideration will be given to all written comments received by April 12, 2021.

# 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 free by contacting Anjanette Suggs by telephone at (202) 354-9660 or by email at                         *suggs.anjanette@dol.gov.*

                        Submit written comments about, or requests for a copy of, this ICR by mail or courier to the U.S. Department of Labor, Office of Workers' Compensation Programs, Room S-3323, 200 Constitution Avenue NW, Washington, DC 20210; by email:                         *suggs.anjanette@dol.gov.*

# FOR FURTHER INFORMATION CONTACT:

                        Contact Anjanette Suggs by telephone at (202) 354-9660 (this is not a toll-free                               ( print page 8805)                            number) or by email at                         *suggs.anjanette@dol.gov.*

# 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 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.

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.

                    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 that does not display a valid Control Number.                     *See*5 CFR 1320.5(a) and 1320.6.                

                    Interested parties are encouraged to provide comments to the contact shown in the                     **ADDRESSES**                     section. Comments must be written to receive consideration, and they will be summarized and included in the request for OMB approval of the final ICR. In order to help ensure appropriate consideration, comments should mention 1240-0044.                

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:*                     Extension.                

*Title of Collection:*                     Health Insurance Claim Form.                

*Form:*                     OWCP-1500.                

*OMB Control Number:*                     1240-0044.                

*Affected Public:*                     Private Sector—businesses or other for-profits.                

*Estimated Number of Respondents:*                     57,099.                

*Frequency:*                     On occasion.                

*Total Estimated Annual Responses:*                     3,381,232.                

*Estimated Average Time per Response:*                     7 minutes.                

*Estimated Total Annual Burden Hours:*                     321,455 hours.                

*Total Estimated Annual Other Cost Burden:*                     $0.                

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

Anjanette Suggs,

Agency Clearance Officer.

[FR Doc. 2021-02636 Filed 2-8-21; 8:45 am]

BILLING CODE 4510-CR-P