[Federal Register Volume 68, Number 191 (Thursday, October 2, 2003)]
[Notices]
[Pages 56819-56820]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-24985]


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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.

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 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 on or 
before December 1, 2003.

ADDRESSES: Written comments and recommendations on the information 
collection should be sent to TRICARE Management Activity--Aurora, 
Office of Program Requirements Division, 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 
Division 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 to determine reimbursement for health care services or supplies

[[Page 56820]]

rendered by individual professional providers to TRICARE beneficiaries. 
The requested information is used to determine beneficiary eligibility, 
appropriations and costs of care, other health insurance liability and 
whether services received are benefits. Use of this form continues 
TRICARE commitments to use the national standard claim form for 
reimbursement of services/supplies provided by individual professional 
providers.
    Affected Public: Business or other form profit, State, local or 
tribal government, Federal government and not for profit institutions.
    Annual Burden Hours: 5,600,000.
    Number of Respondents: 22,400,000.
    Responses per Respondent: 1.
    Average Burden per Response: 15 minutes.
    Frequency: On occasion.

SUPPLEMENTARY INFORMATION:

Summary of Information Collection

    This collection instrument is for is for use by health care 
providers under the TRICARE Program. TRICARE 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 HCFA 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 
beneficiaries. This is the national standard claim from accepted by all 
major commercial and government payers.

    Dated: September 22, 2003.
Patricia L. Toppings,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 03-24985 Filed 10-1-03; 8:45 am]
BILLING CODE 5001-08-M