[Federal Register Volume 65, Number 33 (Thursday, February 17, 2000)]
[Notices]
[Pages 8125-8126]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-3740]


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DEPARTMENT OF DEFENSE

Office of the Secretary


Proposed Collection; Comment Request

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

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 announced 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

[[Page 8126]]

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 April 17, 
2000.

ADDRESSES: Written comments and recommendations on the information 
collection should be sent to TRICARE Management Activity--Aurora, 
Office of Program Requirements, 16401 E. Centretech Parkway, ATTN: 
Graham Kolb, Aurora, CO 80011-9043.

FOR FURTHER INFORMATION CONTACT: To request more information on this 
proposed information collection, please write to the above address or 
call TRICARE Management Activity, Office of Program Requirements at 
(303) 676-3580.
    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: Business or other for profit, State, local or 
tribal government, Federal government and not for profit institutions.
    Annual Burden Hours: 3,625,000.
    Number of Respondents: 14,500,000.
    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/CHAMPUS Program. TRICARE/CHAMPUS is a health benefits 
entitlement program for the dependents of active duty Uniformed 
Services member and deceased sponsors, retirees and their dependents, 
dependents of Department of Transportation (Coast Guard) sponsors, and 
certain North Atlantic Treaty Organizations, 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: February 11, 2000.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 00-3740 Filed 2-16-00; 8:45 am]
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