Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 1215-0176	ICR Reference No: 200609-1215-002
Status: Historical Active	Previous ICR Reference No: 200506-1215-012
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: Uniform Billing Form (UB-92)
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: 01/05/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/23/2006
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2010	36 Months From Approved	01/31/2007
Responses	30,372	0	231,224
Time Burden (Hours)	3,544	0	26,984
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	30,372	231,224	-200,852
Annual Time Burden (Hours)	3,544	26,984	-23,440
Annual Cost Burden (Dollars)	0	0	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: Many of the data fields on the Form OWCP-92 are generated in electronic billing systems already used by hospitals and other institutional medical providers for patient billing, inventories, and bookkeeping. As a result, this reduces the burden hours for any one use of the form. In addition, institutional providers are reducing their use of the form for billing purposes and are moving to other billing formats. For these reasons, OMB Form 83-I shows a net adjustment decrease of -23,440 hours.