00-28797. Submission for OMB Review; Comment Request

November 1, 2000.

The Department of Labor (DOL) has submitted the following public information collection requests (ICRs) to the Office of Management and Budget (OMB) for review and approval in accordance with the Paperwork Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. Chapter 35). A copy of each individual ICR, with applicable supporting documentation, may be obtained by calling the Department of Labor. To obtain documentation for BLS, ETA, PWBA, and OASAM contact Karin Kurz ([phone] or by e-mail to [e-mail]). To obtain documentation for ESA, MSHA, OSHA, and VETS contact Darrin King ([phone] or by e-mail to [e-mail]).

Comments should be sent to Office of Information and Regulatory Affairs, Attn: OMB Desk Officer for BLS, DM, ESA, ETA, MSHA, OSHA, PWBA, or VETS, Office of Management and Budget, Room 10235, Washington, DC 20503 ([phone]), within 30 days from the date of this publication in the Federal Register.

The OMB is particularly interested in comments which:

• Evaluate whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have practical utility;
• 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.

Type of Review: Extension of a currently approved collection.

Agency: Employment Standards Administration (ESA).

Title: Uniform Health Insurance Claim Form—UB-92.

OMB Number: 1215-0176.

Affected Public: Business or other for-profit; not-for-profit institutions; Federal Government; and individuals or households.

Frequency: On occasion.

Number of Respondents: 166,622.

Number of Annual Responses: 166,622.

Estimated Time Per Response: 10 minutes.

Total Burden Hours: 28,538.

Total Annualized Capital/Startup Costs: $0.

Total Annual Costs (operating/maintaining systems or purchasing services): $0.

Description: The Office of Workers Compensation Programs (OWCP) requests hospitals providing medical services to beneficiaries covered under the Federal Employee Compensation Act and the Federal Black Lung Benefits Act to bill on the standard form UB-92. This form identifies the injured worker, the name of the services provided, the conditions being treated and billed amounts. This information is required by OWCP to enable reimbursement for covered services.

Ira L. Mills,

Departmental Clearance Officer.