In accordance
with 5 CFR 1320, the information collection is not approved at this
time. Prior to publication of the final rule, the agency should
provide to OMB a summary of all comments received on the proposed
information collection and identify any changes made in response to
these comments.
Inventory as of this Action
Requested
Previously Approved
01/31/2016
36 Months From Approved
09/30/2016
25,872
0
25,872
4,294
0
4,294
42,689
0
42,689
Form OWCP-915 is used to claim
reimbursement for out-of-pocket covered medical expenses paid by a
beneficiary, and must be accompanied by required billing data
elements (prepared by the medical provider) and by proof of payment
by the beneficiary.
US Code:
42
USC 7384 Name of Law: Energy Employees Occupational Illness
Compensation Program Act of 2000 (EEOICPA)
US Code: 5 USC
8101 Name of Law: Employees Compensation Act
US Code: 30
USC 901 Name of Law: Black Lung Benefits Act
As use of the OWCP-915 form
increases, the total number submitted also increases. For this
reason there is a net Burden adjustment increase of 2,094
hours.
$325,947
No
No
No
No
No
Uncollected
James Paulik 202 693-0304
paulik.james@dol.gov
No
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:
(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;
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.