[Federal Register Volume 61, Number 145 (Friday, July 26, 1996)]
[Notices]
[Page 39121]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-18975]


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DEPARTMENT OF DEFENSE


Proposed Collection; Comment Request

AGENCY: Office of the Assistant Secretary of Defense (Health Affairs).

ACTION: Notice.

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    In compliance with Section 3506(c)(2)(A) of the Paperwork Reduction 
Act of 1995, the Office of the Assistant Secretary of Defense (Health 
Affairs) announces the proposed reinstatement of a public information 
collection and seeks public comments on the provisions thereof. Health 
Affairs invites comments on: (a) Whether the proposed 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 
proposed 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 the use of automated collection techniques or other forms of 
information technology.

DATES: Consideration will be given to all comments received by 
September 24, 1996.

ADDRESSES: Written comments and recommendations on the proposed 
information collection should be sent to: the Office of the Civilian 
Health and Medical Program of the Uniformed Services (OCHAMPUS), 
Program Requirements Branch, Aurora, CO 80045-6900.

FOR FURTHER INFORMATION CONTACT: To request more information on this 
proposed information collection or to obtain a copy of the proposal and 
associated collection instruments, please write to the above address or 
call the OCHAMPUS, Program Requirements Branch at (303) 361-1180.
    Title, Associated Form and OMB Number: Health Insurance Claim Form, 
UB92, OMB Number 0938-0279.
    Needs and Uses: This information collection requirement is 
necessary for a medical institution to claim benefits under the 
CHAMPUS. The information collected will be used by TRICARE/CHAMPUS to 
determine beneficiary eligibility, other health insurance liability, 
certification that the beneficiary received the care and that the 
provider is authorized to receive TRICARE/CHAMPUS payments. The form 
will be used by TRICARE/CHAMPUS and its contractors to determine the 
amount of benefits to be paid to TRICARE/CHAMPUS institutional 
providers.
    Affected Public: Individuals, hospitals, skilled nursing 
facilities, hospices and other medical institutional providers.
    Annual Burden Hours: 525,000 Hours.
    Number of Respondents: 2,100,000.
    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 medical institutions 
filing for reimbursement with CHAMPUS, TRICARE/CHAMPUS is a health 
benefits entitlement program for the dependents of active duty members 
of the Uniformed Services, 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. Use of the UB-92 (also known as HCFA 1450) 
continues TRICARE/CHAMPUS commitments to use the national standard 
claim form for reimbursement of medical services/supplies provided by 
institutional providers.

    Dated: July 22, 1996.
Patricia Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 96-18975 Filed 7-25-96; 8:45 am]
BILLING CODE 5000-04-M