In accordance
with 5 CFR 1320, the information collection is not approved at this
time. Prior to publication of the final rule, the agency should
provide to OMB a summary of all comments received on the proposed
information collection and identify any changes made in response to
these comments.
Inventory as of this Action
Requested
Previously Approved
01/31/2016
36 Months From Approved
05/31/2016
229,997
0
229,997
26,599
0
26,599
0
0
0
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-04. Form OWCP-04 identifies the beneficiary, the
type of services provided, the conditions being treated and billed
amounts. This information is required by OWCP to enable it to pay
providers for covered services.
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: Federal Employee's Compensation Act
(FECA)
US Code: 30
USC 901 Name of Law: Black Lung Benefits Act (BLBA)
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.