[Federal Register Volume 61, Number 47 (Friday, March 8, 1996)]
[Notices]
[Page 9440]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-5554]



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DEPARTMENT OF DEFENSE

Proposed Collection; Comment Request

AGENCY: Office of the Assistant Secretary of Defense for Health 
Affairs.

ACTION: Notice.

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    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 reinstatement of a public 
information 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 May 7, 
1996.

ADDRESSES: Written comments and recommendations on the information 
collection should be sent to Office of the Civilian Health and Medical 
Program of the Uniform Services OCHAMPUS, Fitzsimons Army Medical 
Center, Program Development Branch, ATTN: Mr. Graham Kolb, Aurora, CO 
80045-6900.

FOR FURTHER INFORMATION CONTACT:
To request more information on this proposed information collection, 
please write to the above address or call OCHAMPUS, Program 
Requirements Branch at (303) 361-1180.
TITLE ASSOCIATED FORM AND OMB NUMBER: Health Insurance Claim Form; 
HCFA-1500; OMB Number: 0720-0001.
NEEDS AND USES: This information collection requirement is used by 
TRICARE/CHAMPUS to determine reimbursement for health care services or 
supplies rendered by individual professional providers to TRICARE/
CHAMPUS 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/CHAMPUS commitments to use the 
national standard claim form for reimbursement of services/supplies 
provided by individual professional providers.
AFFECTED PUBLIC: State and local governments, businesses or other for 
profit organizations, Federal agencies and employees, non-profit 
institutions, and small businesses or organizations.

Annual Burden Hours: 3,275,000
Number of Respondents: 13,100,000
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 Civilian Health and Medical Program of the Uniformed Services 
(TRICARE/CHAMPUS). TRICARE/CHAMPUS is a health benefits entitlement 
program for the dependents of active duty Uniformed Services members 
and deceased sponsors, retirees and their dependents, dependents of 
Department of Transportation (Coast Guard) sponsors, and certain North 
Atlantic Treaty Organization, National Oceanic and Atmospheric 
Administration, and Public Health Service eligible beneficiaries. The 
Form 1500 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/CHAMPUS beneficiaries. This is 
the national standard claim form accepted by all major commercial and 
government payers.

    Dated: March 5, 1996.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 96-5554 Filed 3-7-96; 8:45 am]
BILLING CODE 5000-04-M