Daily Rules, Proposed Rules, and Notices of the Federal Government
Submit comments about this request to the Office of Information and Regulatory Affairs, Attn: OMB Desk Officer for DOL-OWCP, Office of Management and Budget, Room 10235, 725 17th Street NW., Washington, DC 20503, Fax: 202-395-6881 (this is not a toll-free number), email:
44 U.S.C. 3507(a)(1)(D).
The OWCP requires an institutional medical provider providing any services to a beneficiary covered under the Federal Employee's Compensation Act, Black Lung Benefits Act, or Energy Employees Occupational Illness Compensation Program Act of 2000 to bill using a form based on the industry standard, Form UB-04. Form OWCP-04 identifies the beneficiary, the type of services provided, the conditions being treated, and the billed amounts. This information enables the OWCP to pay providers for covered services.
This information collection is subject to the PRA. A Federal agency generally cannot conduct or sponsor a collection of information, and the public is generally not required to respond to an information collection, unless it is approved by the OMB under the PRA and displays a currently valid OMB Control Number. In addition, notwithstanding any other provisions of law, no person shall generally be subject to penalty for failing to comply with a collection of information if the collection of information does not display a valid Control Number.
Interested parties are encouraged to send comments to the OMB, Office of Information and Regulatory Affairs at the address shown in the
• Evaluate whether the proposed collection of information is necessary
• Evaluate the accuracy of the agency's estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used;
• Enhance the quality, utility, and clarity of the information to be collected; and
• Minimize the burden of the collection of information on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses.