View Information Collection Request (ICR) Package
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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:
1240-0021
ICR Reference No:
202309-1240-001
Status:
Active
Previous ICR Reference No:
202301-1240-005
Agency/Subagency:
DOL/OWCP
Agency Tracking No:
Title:
Provider Enrollment Form
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
12/05/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/03/2023
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2026
36 Months From Approved
12/31/2023
Responses
23,318
0
64,325
Time Burden (Hours)
9,716
0
32,163
Cost Burden (Dollars)
816
0
37,309
Abstract:
OWCP currently requires all service providers to submit all required medical licenses and the additional attestation language requires providers to further affirm that that they possess all appropriate state, county, locality, or jurisdictional business licenses to provide services to OWCP claimants. Together, these changes will reduce the complexity of the form for the form filler, without adding any additional fillable fields.
Authorizing Statute(s):
US Code:
30 USC 901
Name of Law: The Black Lung Benefits Act (BLBA)
US Code:
5 USC 8101
Name of Law: The Federal Employees' Compensation Act (FECA)
US Code:
42 USC 7384
Name of Law: The Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA)
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
88 FR 42104
06/29/2023
30-day Notice:
Federal Register Citation:
Citation Date:
88 FR 68150
10/03/2023
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Provider Enrollment Form
OWCP-1168
Provider Enrollment Form
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
23,318
64,325
0
-17,689
-23,318
0
Annual Time Burden (Hours)
9,716
32,163
0
-12,730
-9,717
0
Annual Cost Burden (Dollars)
816
37,309
0
393,374
-429,867
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
Minor changes to the form instructions reduced respondent burden from 30 to 25 minutes. Additionally, with the April 2020 change to a new medical processing contractor, current providers were rolled over into the new system without having to complete a new Form OWCP-1168. This change reduced the number of respondents from 64,325 to 23,318, a decrease of 41,007. This resulted in an equivalent decrease in number of responses and attendant decreases to the total respondent burden hours and cost to the federal government. The previously approved number for burden hours was 32,162.5 and the requested number now is 9,717, a decrease of 22,445.5 hours. The previous cost to the federal government was $579,568 and is now $429,867, a decrease of $149,701. Additionally, since enrollment processing time is reduced when providers opt to complete the form online, very few new providers print and mail form 1168, which resulted in reduced cost to respondents. The previous approved annual cost to respondents was $24,997, and the cost requested now is $816, a decrease of $24,181.
Annual Cost to Federal Government:
$429,867
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Anjanette Suggs 202 354-9660 suggs.anjanette@dol.gov
Common Form ICR:
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:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(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;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
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.
Certification Date:
10/03/2023
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