[Federal Register Volume 66, Number 246 (Friday, December 21, 2001)]
[Notices]
[Pages 65937-65938]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-31416]


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DEPARTMENT OF DEFENSE

Office of the Secretary


Submission for OMB Review; Comment Request

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).

DATES: Consideration will be given to all comments received by January 
22, 2002.
    Title, Form Number, and OMB Number. Health Insurance Claim Form; 
HCFA Form 1450 (UB 92); OMB Number 0720-0013.
    Type of Request: Reinstatement.
    Number of Respondents: 7,836.
    Responses Per Respondent: 268 (average).
    Annual Responses: 2,100,000.
    Average Burden Per Response: 15 minutes.
    Annual Burden Hours: 525,000.
    Needs and Uses: This information collection requirement is 
necessary for a medical institution to claim benefits under the Defense 
Health Program, TRICARE, which includes the Civilian Health and Medical 
Program for the Uniformed Services (CHAMPUS). The information collected 
will be used by TRICARE/CHAMPUS to determine beneficially 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. Use of the UB-92, also known 
as the HCFA 1450, continues TRICARE/CHAMPUS commitments to use the 
national standard claim form for reimbursement of medical services/
supplies provided by institutional providers.

[[Page 65938]]

    Affected Public: Individuals or Households; Business or Other For-
Profit; Not-For-Profit.
    Frequency: On Occasion.
    Respondent's Obligation: Required to obtain or retain benefits.
    OMB Desk Officer: Mr. Stuart Shapiro.
    Written comments and recommendations on the proposed information 
collection should be sent to Mr. Shapiro at the Office of Management 
and Budget, Desk Officer for DoD Health Affairs. Room 10235, New 
Executive Office Building, Washington, DC 20503.
    DOD Clearance Officer: Mr. Robert Cushing.
    Written requests for copies of the information collection proposal 
should be sent to Mr. Cushing, WHS/DIOR, 1215 Jefferson Davis Highway, 
Suite 1204, Arlington, VA 22202-4302.

    Dated: December 14, 2001.
Patricia L. Toppings.
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 01-31416 Filed 12-20-01; 8:45 am]
BILLING CODE 5001-08-M