[Federal Register Volume 70, Number 25 (Tuesday, February 8, 2005)]
[Notices]
[Page 6634]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-2381]


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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 announces the proposed extension 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 April 11, 
2005.

ADDRESSES: Written comments and recommendations on the information 
collection should be sent to TRICARE Management Activity--Aurora, 
Office of Program Requirement, 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 With Form, and OMB Number: Health Insurance Claim 
Form, UB 92, OMB Number 0720-0013.
    Needs and Uses: The 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 Uniform Services (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 
it's contractors to determine the amount of benefits to be paid to 
TRICARE/CHAMPUS institutional providers.
    Affected Public: Business or other for-profit; not-for-profit 
institutions.
    Annual Burden Hours: 525,000.
    Number of Respondents: 2,100,000 annually.
    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 the Defense Health Program, TRICARE, 
which includes the Civilian Health and Medical Program of the Uniformed 
Services (TRICARE/CHAMPUS). TRICARE/CHAMPUS is a health benefits 
entitlement program for the dependent of active duty members of the 
Uniformed Service, 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 the HCFA 1450) 
continues TRICARE/CHAMPUS commitments to use the national standard 
claim form for reimbursement of medical services/supplies provided by 
institutional providers.

    Dated: January 31, 2005.
Patricia L. Topplings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 05-2381 Filed 2-7-05; 8:45 am]
BILLING CODE 5001-06-M