Disclosure of Medical Evidence

Forms and Documents

Document Name	Status
1240-0054 Supporting Statement 2019.docx Supporting Statement A	2019-04-01

IC Document Collections

IC ID	Document Title	Status
216185	Disclosure of Medical Evidence	Modified

ICR Details

OMB Control No: 1240-0054	ICR Reference No: 201903-1240-004
Status: Active	Previous ICR Reference No: 201511-1240-003
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Disclosure of Medical Evidence
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/10/2019
	Date Received in OIRA: 05/31/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2022	36 Months From Approved	07/31/2019
Responses	7,465	0	4,074
Time Burden (Hours)	1,244	0	679
Cost Burden (Dollars)	13,138	0	6,681

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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
   US Code: 30 USC 901 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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 10840	03/22/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 25074	05/31/2019
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Disclosure of Medical Evidence

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ICR Summary 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	7,465	4,074	0	0	3,391	0
Annual Time Burden (Hours)	1,244	679	0	0	565	0
Annual Cost Burden (Dollars)	13,138	6,681	0	0	6,457	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: The estimated number of black lung cases adjudicated by OWCP and the Office of Administrative Law Judges has increased by 3,391 to 7,465. The respondents estimated annualized value of the burden hours has increased due to the number of adjudicated cases and also due to wage increase. Annual costs to respondents (Item 13) increased because of increases in postage rates.

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Annual Cost to Federal Government: $0

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 05/31/2019

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