[Federal Register Volume 73, Number 229 (Wednesday, November 26, 2008)]
[Notices]
[Pages 72031-72032]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-28149]


-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID: DoD-2008-HA-0098]


Submission for OMB Review; Comment Request

ACTION: Notice.

-----------------------------------------------------------------------

    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 December 
26, 2008.
    Title and OMB Number: Health Insurance Claim Form, UB-04 CMS-1450, 
OMB Control Number 0720-0013.
    Type of Request: Extension.
    Number of Respondents: 8,500,000.
    Responses per Respondent: 1.
    Annual Responses: 8,500,000.
    Average Burden per Response: 15 minutes.
    Annual Burden Hours: 2,125,000.
    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 its 
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.
    Frequency: On occasion.
    Respondent's Obligation: Required to obtain or retain benefits.
    OMB Desk Officer: Mr. John Kraemer.
    Written comments and recommendations on the proposed information 
collection should be sent to Mr. Kraemer at the Office of Management 
and Budget, Desk Officer for DoD, Room 10236, New Executive Office 
Building, Washington, DC 20503.
    You may also submit comments, identified by docket number and 
title, by the following method:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
    Instructions: All submissions received must include the agency 
name, docket number and title for this Federal Register document. The 
general policy for comments and other submissions from members of the 
public is to make these submissions available for public viewing on the 
Internet at http://www.regulations.gov as they are received without 
change, including any personal identifiers or contact information.
    DOD Clearance Officer: Ms. Patricia Toppings.
    Written requests for copies of the information collection proposal 
should be sent to Ms. Toppings at WHS/ESD/Information Management 
Division, 1777 North Kent Street, RPN, Suite 11000, Arlington, VA 
22209-2133.


[[Page 72032]]


    Dated: November 18, 2008.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E8-28149 Filed 11-25-08; 8:45 am]
BILLING CODE 5001-06-P