Justification for 1240-0021 - OWCP Provider Enrollment Form

Justification for No material/Non-substantive Change

OWCP 1168 Provider Enrollment Form (OWCP-1168/PE-1168)

The Department of Labor’s Office of Workers’ Compensation Programs (OWCP) is the agency responsible for administration of the Federal Employees’ Compensation Act (FECA), 5 U.S.C. 8101 et. seq., the Black Lung Benefits Act (BLBA), 30 U.S.C. 901 et. seq. and the Energy Employees’ Occupational Illness Compensation Program Act of 2000 (EEOICPA), 42 U.S.C. 7384 et. seq.  These statutes require OWCP to pay for appropriate medical and vocational rehabilitation services provided to beneficiaries.

OWCP is requesting to add labels to the section headers indicating required or optional sections to form OWCP-1168, Provider Enrollment Form, and attestation language to page 8 of the form. Additionally, the form was edited to add a non-medical business licensing attestation statement to the existing list of attestations. 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.

Approval of this request is needed by January 30, 2023. This will alleviate enrollment challenges for providers. Any approval date beyond January 30, 2023, would continue to deter or delay the complex provider enrollment process until the request is approved.