[Federal Register Volume 80, Number 87 (Wednesday, May 6, 2015)]
[Notices]
[Pages 26009-26010]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-10509]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID: DoD-2015-HA-0038]


Proposed Collection; Comment Request

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

ACTION: Notice.

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SUMMARY: In compliance with 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 July 6, 
2015.

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: Department of Defense, Office of the Deputy Chief 
Management Officer, Directorate of Oversight and Compliance, Regulatory 
and Audit Matters Office, 9010 Defense Pentagon, Washington, DC 20301-
9010.
    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.
    Any associated form(s) for this collection may be located within 
this same electronic docket and downloaded for review/testing. Follow 
the instructions at http://www.regulations.gov for submitting comments. 
Please submit comments on

[[Page 26010]]

any given form identified by docket number, form number, and title.

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 the Defense Health 
Agency, TRICARE, Medical Benefits & Reimbursement Office, 16401 E. 
Centretech Parkway, Aurora, CO 80011, ATTN: Amber Butterfield, or call 
TRICARE, Medical Benefits and Reimbursement Office at (303) 676-3565.

SUPPLEMENTARY INFORMATION: 
    Title; Associated Form; and OMB Number: Health Insurance Claim 
Form, CMS-1500 OMB Control Number 0720-0001.
    Needs and Uses: The 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 cost of care, other health insurance liability and 
whether services received are covered benefits.
    Affected Public: Business or other for profit; Not-for-profit 
institutions, Federal government, state, local or tribal government.
    Annual Burden Hours: 22,108,225.
    Number of Respondents: 88,432,900.
    Responses per Respondent: 1.
    Average Burden per Response: 15 minutes.
    Frequency: On occasion.
    Respondents are individual professional providers or healthcare 
related providers, who file for reimbursement of civilian health care 
services or supplies provided to TRICARE beneficiaries under the 
Civilian Health and Medical Program of the Uniformed Services. TRICARE 
is a health benefits entitlement program for active duty, the 
dependents of active duty Uniformed Services member 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. 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 or healthcare related providers, and is accepted 
by all major commercial and government payers.

    Dated: April 30, 2015.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2015-10509 Filed 5-5-15; 8:45 am]
BILLING CODE 5001-06-P