[Federal Register Volume 77, Number 31 (Wednesday, February 15, 2012)]
[Notices]
[Pages 8820-8821]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-3517]


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

DEPARTMENT OF DEFENSE

Office of the Secretary

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


Proposed Collection; Comment Request

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

ACTION: Notice.

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

SUMMARY: In compliance 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 a proposed public information collection 
and seeks public comment on the provisions thereof. Comments are 
invited on: (a) Whether the proposed 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 proposed 
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 March 
26, 2012.

ADDRESSES: You may submit comments, identified by docket 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, 4800 Mark Center 
Drive, 2nd Floor, East Tower, Suite 02G09, Alexandria, VA 22350-3100.
    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

[[Page 8821]]

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 or to obtain a copy of the proposal and 
associated collection instruments, please write to TRICARE Management 
Activity, Purchased Care Procurement Branch, 16401 E. Centretech 
Parkway, Aurora, CO 80011-9066, or telephone (303) 676-3613.
    Title; Associated Form; and OMB Number: Health Insurance Claim 
Form, UB-04 CMS-1450, 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 
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.
    Annual Burden Hours: 2,125,000.
    Number of Respondents: 8,500,000.
    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 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 dependents 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-04 CMS1450 continues TRICARE/
CHAMPUS commitments to use the national standard claim form for 
reimbursement of medical services/supplies provided by institutional 
providers.

    Dated: January 31, 2012.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2012-3517 Filed 2-14-12; 8:45 am]
BILLING CODE 5001-06-P