[Federal Register Volume 75, Number 247 (Monday, December 27, 2010)]
[Notices]
[Pages 81241-81242]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-32393]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket ID DOD-2010-OS-0175]
Proposed Collection; Comment Request
AGENCY: Office of the Assistant Secretary of Defense for Health
Affairs, DoD.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: In accordance with Section 3506(c)(2)(A) of the Paperwork
Reduction Act of 1995, the Office of the Assistant Secretary of Defense
for Health Affairs announces the proposed extension of a currently
approved collection and seeks public comment on the provisions thereof.
Comments are invited on: (a) Whether the proposed extension of
collection of information is necessary for the proper performance of
the functions of the agency, including whether the information shall
have practical utility; (b) the accuracy of the agency's estimate of
the burden of the information collection; (c) ways to enhance the
quality, utility, and clarity of the information to be collected; and
(d) ways to minimize the burden of the information collection on
respondents, including through the use of automated collection
techniques or other forms of information technology.
DATES: Consideration will be given to all comments received by February
25, 2011.
ADDRESSES: You may submit comments, identified by document number and
title by any of the following methods:
Federal eRulemaking Portal: http://www.regulations.gov.
Follow the instructions for submitting comments.
Mail: Federal Docket Management System Office, Room 3C843,
1160 Defense Pentagon, Washington, DC 20301-1160.
Instructions: All submissions received must include the agency
name, docket number and title for this Federal Register document. The
general policy for comments and other submissions from members of the
public is to make these submissions available for public viewing on the
Internet at http://www.regulations.gov as they are received without
change, including any personal identifiers or contact information.
FOR FURTHER INFORMATION CONTACT: To request more information on this
proposed information collection, please write to the TRICARE Management
Activity--Aurora, Performance Evaluation and Transition Management
Branch, 16401 E. Centretech Parkway,
[[Page 81242]]
Attn; John J.M. Leininger, Aurora, CO 80011-9066 or call TRICARE
Management Activity--Aurora, Performance Evaluation and Transition
Management Branch, at (303) 676-3613.
Title, Associated Form and OMB Number: Health Insurance Claim Form,
CMS-1500, OMB Control Number 0720-0001.
Needs and Uses: This information collection requirement is used by
TRICARE to determine reimbursement for health care services or supplies
rendered by individual professional providers to TRICARE beneficiaries.
The requested information is used to determine beneficiary eligibility,
appropriateness and costs of care, other health insurance liability and
whether services received are benefits. Use of this form continues
TRICARE's commitment to use the national standard claim form for
reimbursement of services/supplies provided by individual professional
providers.
Affected Public: Business or other for profit institutions, not-
for-profit institutions, Federal government, state, local or tribal
government.
Annual Burden Hours: 21,500,000.
Number of Respondents: 86,000,000.
Responses per Respondent: 1.
Average Burden per Response: 15 minutes.
Frequency: On occasion.
SUPPLEMENTARY INFORMATION:
Summary of Information Collection
This collection instrument is for use by health care providers
under the TRICARE Program. TRICARE is a health benefits entitlement
program for active duty, the dependents of active duty Uniformed
Services members and deceased sponsors, retirees and their dependents,
dependents of Department of Homeland Security (Coast Guard) sponsors,
and certain North Atlantic Treaty Organizations, National Oceanic and
Atmospheric Administration, and Public Health Service eligible
beneficiaries. The CMS-1500 Form is used by individual professional
health care or health care related providers to file for reimbursement
of civilian health care services or supplies provided to TRICARE
beneficiaries. This is the national standard claim form accepted by all
major commercial and government payers.
Dated: December 20, 2010.
Morgan F. Park,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010-32393 Filed 12-23-10; 8:45 am]
BILLING CODE 5001-06-P