[Federal Register: August 29, 2008 (Volume 73, Number 169)]
[Notices]
[Page 50946-50947]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr29au08-50]
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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
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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 the proposed extension of a public
information collection and seeks public comment on the provisions
thereof. Comments are
[[Page 50947]]
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 October
28, 2008.
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, 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 or to obtain a copy of the proposal and
associated collection instruments, please write to TRICARE Management
Activity, Purchased Care Procurement Branch, ATTN: John J.M. Leininger,
16401 E. Centretech Parkway, Aurora, CO 80011-9066, 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 dependent 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: August 22, 2008.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E8-20034 Filed 8-28-08; 8:45 am]
BILLING CODE 5001-06-P