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###### Department of Labor

###### Employment Standards Administration

# ACTION:

Notice.

# SUMMARY:

The Department of Labor (DOL), as part of its continuing effort to reduce paperwork and respondent burden, conducts a preclearance consultation program to provide the general public and Federal agencies with an opportunity to comment on proposed and/or continuing collections of information in accordance with the Paperwork Reduction Act of 1995 (PRA95) [44 U.S.C. 3506(c)(2)(A)]. This program helps to ensure that 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 on respondents can be properly assessed. Currently, the Employment Standards Administration is soliciting comments concerning its proposal to extend OMB approval of the information collection: Health Insurance Claim Form (OWCP-1500). A copy of the proposed information collection request can be obtained by contacting the office listed below in the addresses section of this Notice.

# DATES:

Written comments must be submitted to the office listed in the addresses section below on or before May 11, 2009.

# ADDRESSES:

                        Mr. Steven D. Lawrence, U.S. Department of Labor, 200 Constitution Ave., NW., Room S-3201, Washington, DC 20210, telephone (202) 693-0292, fax (202) 693-1451, e-mail                         *Lawrence.Steven@dol.gov.*                         Please use only one method of transmission for comments (mail, fax, or e-mail).                    

# SUPPLEMENTARY INFORMATION:

## I. Background

                    The Office of Workers' Compensation Programs (OWCP) is the agency responsible for administration of the Federal Employees' Compensation Act (FECA), 5 U.S.C. 8101*et seq.*, the Black Lung Benefits Act (BLBA), 30 U.S.C. 901*et seq.*, and the Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA), 42 U.S.C. 7384*et seq.*                     All three of these statutes require that OWCP pay for medical treatment of beneficiaries; BLBA also requires that OWCP pay for medical examinations and related diagnostic services to determine eligibility for benefits under that statute. 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. To consider the appropriateness of the requested payment in a timely fashion, it is essential that provider bills be submitted on a standard form that will capture the critical data elements needed to evaluate the bill, such as procedure and diagnosis codes.                

This information collection is currently approved for use through October 31, 2009.

## II. Review Focus

The DOL is particularly interested in comments which:
    - 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 submissions of responses.                            ( print page 10779)      

## III. Current Actions

                    The DOL seeks the approval for the extension of this currently approved information collection.                     *Type of Review:*                     Extension.                

*Agency:*                     Employment Standards Administration.                

*Title:*                     Health Insurance Claim Form (OWCP-1500).                

*OMB Number:*                     1215-0055.                

*Agency Number:*                     OWCP-1500.                

*Affected Public:*                     Individuals or households, businesses or other for-profit.                

*Total Respondents:*                     749,104.                

*Total Responses:*                     2,996,416.                

*Time per Response:*                     7 minutes.                

*Frequency:*                     On occasion and annually.                

*Estimated Total Burden Hours:*                     359,358.                

*Total Burden Cost (Capital/Startup):*                     $0.                

*Total Burden Cost (Operating/Maintenance):*                     $5,368,809.                

Comments submitted in response to this notice will be summarized and/or included in the request for Office of Management and Budget approval of the information collection request; they will also become a matter of public record.

Dated: March 9, 2009.

Hazel Bell,

Acting Chief, Branch of Management Review and Internal Control, Division of Financial Management, Office of Management, Administration and Planning, Employment Standards Administration.

 [FR Doc. E9-5368 Filed 3-11-09; 8:45 am]

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