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###### Department of Labor

###### Employment Standards Administration

# ACTION:

Notice.

# SUMMARY:

                        The Department of Labor, 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 the Office of Management and Budget (OMB) approval of the Information Collection: Uniform Billing Form (OWCP-04). 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 August 24, 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; this medical treatment can include inpatient/outpatient hospital services, as well as services provided by nursing homes and skilled nursing facilities. 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 (which includes the first page of the private sector Form 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, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), by various other government health care programs, and by the private sector, to request payment to institutional providers of medical services. The paper UB-04 has been designed by the National Uniform Billing Committee and is neither a government-printed form nor distributed by OWCP; OWCP has, however, developed detailed instructions to ensure that it obtains the information it needs to consider requests for payment from institutional providers using this form. This information collection is currently approved for use through January 31, 2010.

*II. Review Focus:*                     The Department of Labor 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 submissions of responses.

*III. Current Actions:*                     The Department of Labor seeks approval for the extension of this information collection in order to carry out its responsibility to provide payment covered medical services to injured employees who are covered under the FECA, BLBA and the EEOICPA.                

*Type of Review:*                     Extension.                

*Agency:*                     Employment Standards Administration.                

*Title:*                     Uniform Billing Form (OWCP-04).                

*OMB Number:*                     1215-0176.                

*Affected Public:*                     Individuals or households; Business or other for-profit; Not-for-profit institutions.                

*Total Respondents:*                     5,481.                

*Total Annual responses:*                     21,924.                

*Estimated Total Burden Hours:*                     2,558.                

*Estimated Time Per Response:*                     7 minutes.                

*Frequency:*                     Annually.                

*Total Burden Cost (capital/startup):*                     $0.                

*Total Burden Cost (operating/maintenance):*                     $0.                

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: June 18, 2009.

Steven D. Lawrence,

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

[FR Doc. E9-14688 Filed 6-22-09; 8:45 am]

BILLING CODE 4510-CH-P