[Federal Register Volume 75, Number 247 (Monday, December 27, 2010)]
[Notices]
[Pages 81241-81242]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-32393]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID DOD-2010-OS-0175]


Proposed Collection; Comment Request

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

ACTION: Notice.

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SUMMARY: 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 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 by February 
25, 2011.

ADDRESSES: You may submit comments, identified by document number and 
title by any of the following methods:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
     Mail: Federal Docket Management System Office, Room 3C843, 
1160 Defense Pentagon, Washington, DC 20301-1160.
    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.

FOR FURTHER INFORMATION CONTACT: To request more information on this 
proposed information collection, please write to the TRICARE Management 
Activity--Aurora, Performance Evaluation and Transition Management 
Branch, 16401 E. Centretech Parkway,

[[Page 81242]]

Attn; John J.M. Leininger, Aurora, CO 80011-9066 or call TRICARE 
Management Activity--Aurora, Performance Evaluation and Transition 
Management Branch, at (303) 676-3613.
    Title, Associated Form and OMB Number: Health Insurance Claim Form, 
CMS-1500, OMB Control Number 0720-0001.
    Needs and Uses: This information collection requirement is used by 
TRICARE to determine reimbursement for health care services or supplies 
rendered by individual professional providers to TRICARE 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's commitment to use the national standard claim form for 
reimbursement of services/supplies provided by individual professional 
providers.
    Affected Public: Business or other for profit institutions, not-
for-profit institutions, Federal government, state, local or tribal 
government.
    Annual Burden Hours: 21,500,000.
    Number of Respondents: 86,000,000.
    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 Program. TRICARE is a health benefits entitlement 
program for active duty, the dependents of active duty Uniformed 
Services members and deceased sponsors, retirees and their dependents, 
dependents of Department of Homeland Security (Coast Guard) sponsors, 
and certain North Atlantic Treaty Organizations, National Oceanic and 
Atmospheric Administration, and Public Health Service eligible 
beneficiaries. The CMS-1500 Form 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 form accepted by all 
major commercial and government payers.

    Dated: December 20, 2010.
Morgan F. Park,
 Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010-32393 Filed 12-23-10; 8:45 am]
BILLING CODE 5001-06-P