[Federal Register: October 2, 2003 (Volume 68, Number 191)]
[Notices]
[Page 56819-56820]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr02oc03-30]
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DEPARTMENT OF DEFENSE
Office of the Secretary
Proposed Collection; Comment Request
AGENCY: Office of the Assistant Secretary of Defense for Health
Affairs.
ACTION: Notice.
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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 announced 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 on or
before December 1, 2003.
ADDRESSES: Written comments and recommendations on the information
collection should be sent to TRICARE Management Activity--Aurora,
Office of Program Requirements Division, 16401 E. Centretech Parkway,
ATTN: Graham Kolb, Aurora, CO 80011-9043.
FOR FURTHER INFORMATION CONTACT: To request more information on this
proposed information collection, please write to the above address or
call TRICARE Management Activity, Office of Program Requirements
Division at (303) 676-3580.
Title, Associated Form, and OMB Number: Health Insurance Claim
Form, HCFA-1500, OMB Number 0720-0001
Needs and Uses: This information collection requirement is used by
TRICARE to determine reimbursement for health care services or supplies
[[Page 56820]]
rendered by individual professional providers to TRICARE beneficiaries.
The requested information is used to determine beneficiary eligibility,
appropriations and costs of care, other health insurance liability and
whether services received are benefits. Use of this form continues
TRICARE commitments to use the national standard claim form for
reimbursement of services/supplies provided by individual professional
providers.
Affected Public: Business or other form profit, State, local or
tribal government, Federal government and not for profit institutions.
Annual Burden Hours: 5,600,000.
Number of Respondents: 22,400,000.
Responses per Respondent: 1.
Average Burden per Response: 15 minutes.
Frequency: On occasion.
SUPPLEMENTARY INFORMATION:
Summary of Information Collection
This collection instrument is for is for use by health care
providers under the TRICARE Program. TRICARE is a health benefits
entitlement program for the dependents of active duty Uniformed
Services member and deceased sponsors, retirees and their dependents,
dependents of Department of Transportation (Coast Guard) sponsors, and
certain North Atlantic Treaty Organizations, National Oceanic and
Atmospheric Administration, and Public Health Service eligible
beneficiaries. The Form HCFA 1500 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 from accepted by all
major commercial and government payers.
Dated: September 22, 2003.
Patricia L. Toppings,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 03-24985 Filed 10-1-03; 8:45 am]
BILLING CODE 5001-08-M