[Federal Register Volume 82, Number 91 (Friday, May 12, 2017)]
[Notices]
[Pages 22127-22128]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-09620]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID: DOD-2015-HA-0008]


Submission for OMB Review; Comment Request

ACTION: Notice.

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SUMMARY: 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.

DATES: Consideration will be given to all comments received by June 12, 
2017.

FOR FURTHER INFORMATION CONTACT: Fred Licari, 571-372-0493.

SUPPLEMENTARY INFORMATION:
    Title, Associated Form and OMB Number: Health Insurance Claims 
Form; UB-04 CMS 1450; OMB Control Number 0720-0013.
    Type of Request: Reinstatement.
    Number of Respondents: 10,318.
    Responses per Respondent: 83.241.
    Annual Responses: 858,881.
    Average Burden per Response: 16 minutes.
    Annual Burden Hours: 41,884.
    Needs and Uses: This information collection requirement is 
necessary for a medical institution to claim benefit under the Defense 
Health Agency, TRICARE, which includes the Civilian Health and Medical 
Program of the Uniformed Services (CHAMPUS). The information collected 
will be used by CHAMPUS/TRICARE contractors to determine beneficiary 
eligibility, other health insurance liability, certification that the 
beneficiary received the care and that the provider is authorized to 
receive CHAMPUS/TRICARE payments.
    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: Ms. Stephanie Tatham.
    Comments and recommendations on the proposed information collection 
should be emailed to Ms. Stephanie Tatham, DoD Desk Officer, at 
[email protected]. Please identify the proposed information 
collection by DoD Desk Officer and the Docket ID number and title of 
the information collection.
    You may also submit comments and recommendations, identified by 
Docket ID 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 ID 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: Mr. Frederick Licari.
    Written requests for copies of the information collection proposal 
should be sent to Mr. Licari at WHS/ESD Directives Division, 4800 Mark 
Center Drive, East Tower, Suite 03F09, Alexandria, VA 22350-3100.


[[Page 22128]]


    Dated: May 8, 2017.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2017-09620 Filed 5-11-17; 8:45 am]
 BILLING CODE 5001-06-P