[Federal Register Volume 59, Number 145 (Friday, July 29, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-18533]


[[Page Unknown]]

[Federal Register: July 29, 1994]


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DEPARTMENT OF DEFENSE

 

Public Information Collection Requirement Submitted to the Office 
of Management and Budget (OMB) for Review

ACTION: Notice.

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    The Department of Defense has submitted to OMB for clearance, the 
following proposal for collection of information under the provisions 
of the Paperwork Reduction Act (44 U.S.C. Chapter 35).

Title; Applicable Form; and OMB Control Number: Health Insurance Claim 
Form; HCFA 1500; OMB Control Number 0720-0001.
Type of Request: Revision
Number of Respondents: 9,550,000
Responses Per Respondent: 1
Annual Responses: 9,550,000
Average Burden Per Response: 15 minutes
Annual Burden Hours: 2,387,500
Needs and Uses: The information collected hereby, is used by CHAMPUS to 
determine reimbursement for health care services or supplies rendered 
by individual professional providers to CHAMPUS beneficiaries. It is 
used to verify beneficiary eligibility, appropriateness and cost of 
care, other health insurance liability, and whether services received 
are benefits. Use of this form continues the CHAMPUS commitment to use 
the national standard claim form for reimbursement of services or 
supplies provided by individual professional providers.
Affected Public: Individuals or households; State or local governments; 
Businesses or other for-profit; Federal agencies or employees; Non-
profit institutions; and Small businesses or organizations.
Frequency: On occasion.
Respondent's Obligation: Required to obtain or retain a benefit.
OMB Desk Officer: Ms. Shannah Koss.

    Written comments and recommendations on the proposed information 
collection should be sent to Ms. Koss at the Office of Management and 
Budget, Desk Officer for DoD, Room 10235, New Executive Office 
Building, Washington, DC 20503.

DOD Clearance Officer: Mr. William P. Pearce.

    Written requests for copies of the information collection proposal 
should be sent to Mr. Pearce, WHS/DIOR, 1215 Jefferson Davis Highway, 
Suite 1204, Arlington, VA 22202-4302.

    Dated: July 26, 1994.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 94-18533 Filed 7-28-94; 8:45 am]
BILLING CODE 5000-04-M