Authorization Request Forms/Certification/Letter of Medical Necessity

ICR 201906-1240-001

OMB: 1240-0055

Federal Form Document

ICR Details
1240-0055 201906-1240-001
Received in OIRA 201705-1240-001
DOL/OWCP
Authorization Request Forms/Certification/Letter of Medical Necessity
Reinstatement without change of a previously approved collection   No
Regular 02/12/2020
  Requested Previously Approved
36 Months From Approved
45,600 0
22,800 0
0 0

The forms, Authorization Request Form and Certification/Letter of Medical Necessity for Compounded Drugs (CA-26) and Authorization Request Form and Certification/Letter of Medical Necessity Certification/Letter of Medical Necessity for Opioid Medications (CA-27), require an injured worker’s treating physician to answer a number of questions about the prescribed opioids and/or compounded drugs and certify that they are medically necessary to treat the work-related injury. The responses to the questions on the forms are intended to ensure that treating physicians have considered non-opioid and non-compounded drug alternatives, and are only prescribing the most cost effective and medically necessary drugs. The forms will also permit OWCP to more easily track the volume, type, and characteristics of opioids and compounded drugs authorized by the FECA program. The forms will serve as a means for injured workers to continue receiving opioids and compounded drugs only where medically necessary and simultaneously give OWCP greater oversight in monitoring their appropriate use and gather additional data about their use.

US Code: 5 USC 8103 Name of Law: Federal Employees' Comensation Act
   US Code: 5 USC 8145 Name of Law: Federal Employees' Comensation Act
   US Code: 5 USC 8124 (a) (2) Name of Law: Federal Employees' Comensation Act
   US Code: 5 USC 8149 Name of Law: Federal Employees' Comensation Act
  
None

Not associated with rulemaking

  84 FR 59842 11/06/2019
85 FR 8029 02/12/2020
No

  Total Request 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 45,600 0 0 0 -124,400 170,000
Annual Time Burden (Hours) 22,800 0 0 0 -62,200 85,000
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
There is a reduction in the number of respondents from the previous submission of 170,000 to 45,600, a difference of 124,400. Accordingly, the previous burden hours of 85, 000 is adjusted to 22,800, a decrease of 62,200. There are no associated burden costs. The adjustments are reflective of enhanced oversight by OWCP for both compound and opioid prescriptions that includes the implementation of the four point strategic plan noted above.

$7,032,502
No
    No
    No
No
No
No
No
Anjanette Suggs 202 354-9660 suggs.anjanette@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.
02/12/2020


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