82 FR 12143 - Comment Request for Review of a Revised Information Collection: Multi-State Plan Program External Review Case Intake Form, OPM Form 1840

OFFICE OF PERSONNEL MANAGEMENT

Federal Register Volume 82, Issue 38 (February 28, 2017)

The Office of Personnel Management (OPM) intends to submit to the Office of Management and Budget (OMB) a request for review of a revision of a currently approved collection, the Multi-State Plan Program External Review Intake Form, OPM Form 1840. Approval of the revised Multi-State Plan Program External Review Intake Form is necessary to improve the collection of information from members of the Multi-State Plan Program who need to request the external review of a disputed adverse benefit decision.

[Federal Register Volume 82, Number 38 (Tuesday, February 28, 2017)]
[Notices]
[Pages 12143-12144]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-03869]


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OFFICE OF PERSONNEL MANAGEMENT


Comment Request for Review of a Revised Information Collection: 
Multi-State Plan Program External Review Case Intake Form, OPM Form 
1840

AGENCY: Office of Personnel Management.

ACTION: Notice.

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SUMMARY: The Office of Personnel Management (OPM) intends to submit to 
the Office of Management and Budget (OMB) a request for review of a 
revision of a currently approved collection, the Multi-State Plan 
Program External Review Intake Form, OPM Form 1840. Approval of the 
revised Multi-State Plan

[[Page 12144]]

Program External Review Intake Form is necessary to improve the 
collection of information from members of the Multi-State Plan Program 
who need to request the external review of a disputed adverse benefit 
decision.

DATES: Comments due by May 1, 2017.

ADDRESSES: Send or deliver comments to: Donna Lease Batdorf, Multi-
State Plan Program National Healthcare Operations, Healthcare and 
Insurance, Office of Personnel Management, 1900 E Street NW., Room 
3468, Washington, DC 20415.

FOR FURTHER INFORMATION CONTACT: FOR INFORMATION REGARDING 
ADMINISTRATIVE COORDINATION CONTACT: For copies of this proposal, 
contact C.C. ``Corky'' Conyers, Ph.D., C.I.O. P.R.A./Forms Officer at 
(202) 606-0125, or via email to [email protected]. Please include 
a mailing address with your request.

SUPPLEMENTARY INFORMATION: As required by the Paperwork Reduction Act 
of 1995 (Pub. L. 104-13, May 22, 1995), as amended by the Clinger-Cohen 
Act (Pub. L. 104-106), OPM is soliciting comments for this collection. 
The previous collection (OMB No. 3206-0263) was published in the 
Federal Register on November 26, 2013 at 78 FR 70598. Comments are 
particularly invited on:
    1. Whether this collection of information is necessary for the 
proper performance of functions of the Office of Personnel Management, 
and whether it will have practical utility;
    2. Whether our estimate of the public burden of this collection is 
accurate, and based on valid assumptions and methodology; and
    3. Ways in which we can minimize the burden of the collection of 
information on those who are to respond, through the use of the 
appropriate technological collection techniques or other forms of 
information technology.

Analysis

    Agency: Multi-State Plan Program, National Healthcare Operations, 
Healthcare and Insurance, Office of Personnel Management.
    Title: External Review Intake Form.
    OMB: 3206-0263.
    Frequency:
    Affected Public: Individuals or Households.
    Number of Respondents: 800.
    Estimated Time Per Respondent: 60 minutes.
    Total Burden Hours: 800 hours.

Kathleen M. McGettigan,
Acting Director, U.S. Office of Personnel Management.
[FR Doc. 2017-03869 Filed 2-27-17; 8:45 am]
 BILLING CODE 6325-64-P