Form OWCP-915 is used to claim
reimbursement for out-of-pocket covered medical expenses paid by a
beneficiary, and must be accompanied by required billing data
elements (prepared by the medical provider) and by proof of payment
by the beneficiary.
US Code:
42
USC 7384 Name of Law: Energy Employees Occupational Illness
Compensation Program Act of 2000 (EEOICPA)
US Code: 5 USC
8101 Name of Law: Employees Compensation Act
US Code: 30
USC 901 Name of Law: Black Lung Benefits Act
Due to the continuing decline
in the number of BLBA beneficiaries currently in the program, the
increase in the number of EEOICPA beneficiaries in the program, and
the increase in the number of medical providers billing OWCP
directly for medical services in the FECA progrram rather than
billing their patients, who then would have to seek reimbursement
from OWCP using Form OWCP-915, there is a change of -3036 burdens
hours. There is no change reported for the operational and
maintenance costs.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.