Justification for No material/Nonsubstantive Change (OWCP-04)

Justification - OWCP-04.docx

Uniform Billing Form

Justification for No material/Nonsubstantive Change (OWCP-04)

OMB: 1240-0019

Document [docx]
Download: docx | pdf

Justification for No material/Nonsubstantive Change

Uniform Billing Form (OWCP-04)

The Department of Labor’s Office of Workers’ Compensation Programs (OWCP) is the agency responsible for administration of the Federal Employees’ Compensation Act (FECA), 5 U.S.C. 8101 et. seq., the Black Lung Benefits Act (BLBA), 30 U.S.C. 901 et. seq. and the Energy Employees’ Occupational Illness Compensation Program Act of 2000 (EEOICPA), 42 U.S.C. 7384 et. seq.  These statutes require OWCP to pay for appropriate medical and vocational rehabilitation services provided to beneficiaries. OWCP is requesting an address change to OWCP billing form Uniform Billing Form (OWCP-04) as the OWCP medical bill processor has procured a new mailroom and requires a means to receive those forms.

Approval of this request is needed by October 1, 2020, for posting of the form on the medical bill processors web portal. This will allow ample time for the new mailroom contractor’s assumption of operations on October 1, 2020. Any approval date beyond would necessitate a delay in operations until the request is approved.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSuggs, Anjanette C - OWCP
File Modified0000-00-00
File Created2021-01-13

© 2024 OMB.report | Privacy Policy