OMB-83C Justification for 1215-0176

OMB-83-C, Justification for OMB-1215-0176

OWCP requires institutional medical providers who provide services to beneficiaries covered under FECA, BLBA and EEOICPA to bill using a form based on the industry standard, the UB-92. Form OWCP-92 identifies the beneficiary, the type of services provided, and the conditions being treated and billed amounts. This information is required by OWCP to enable it to pay providers for covered services. On January 5, 2007, Form OWCP-92, which incorporates the first page of the paper UB-92, was renewed for three years in OMB Control NO. 1215-0176. However, the National Uniform billing Committee (a non-governmental body) has recently made minor changes to the UB-92 to accommodate reporting of the National Provider Identifier (NPI), and has renamed the form as the UB-04. Since the OWCP-92 incorporates the first page of this collection instrument, this 83-C is being submitted to accommodate the incorporation of the revised UB-04 into the OWCP-92, which has been renamed as the OWCP-04. No change is sought in the expiration date of January 31, 2010.