Disclosure of Medical Evidence

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
1240-0054 Supporting Statment - Disclosure of Medical Evidence.docx	Supporting Statement A	Uploaded 2016-03-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
216185	Disclosure of Medical Evidence		Modified

ICR Details

OMB Control No: 1240-0054	ICR Reference No: 201511-1240-003
Status: Historical Active	Previous ICR Reference No: 201504-1240-002
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Disclosure of Medical Evidence
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/03/2016
	Date Received in OIRA: 03/16/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2019	36 Months From Approved
Responses	4,074	0	0
Time Burden (Hours)	679	0	0
Cost Burden (Dollars)	6,681	0	0

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Abstract: OWCP is engaging in this rulemaking to address a variety of programmatic issues that have arisen in administering the Black Lung Benefits Act. Among them, the current rules do not address whether the parties must disclose medical evidence they develop in connection with a claim for benefits and generally provide that payment for medical treatment and services is capped at the rate prevailing in the community where the service provider is located but provide no method for determining that rate. To ensure that coal miners have full access to information about their health and to enhance the accuracy of entitlement determinations, this rule would address disclosure of medical evidence. It would also amend rules governing payment of medical treatment and services to incorporate the fee schedule used in other OWCP-administered programs, and address a liable party's responsibility to pay benefits under an effective award while pursuing modification.

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Authorizing Statute(s): US Code: 30 USC 936 Name of Law: Black Lung Benefits Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1240-AA10	Final or interim final rulemaking	81 FR 24464	04/26/2016

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 23743	04/29/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 23743	04/29/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Disclosure of Medical Evidence

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	4,074	0	0	4,074	0	0
Annual Time Burden (Hours)	679	0	0	679	0	0
Annual Cost Burden (Dollars)	6,681	0	0	6,681	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/16/2016

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