[Federal Register Volume 61, Number 47 (Friday, March 8, 1996)]
[Notices]
[Page 9440]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-5554]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Proposed Collection; Comment Request
AGENCY: Office of the Assistant Secretary of Defense for Health
Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
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 announces the proposed reinstatement of a public
information 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 May 7,
1996.
ADDRESSES: Written comments and recommendations on the information
collection should be sent to Office of the Civilian Health and Medical
Program of the Uniform Services OCHAMPUS, Fitzsimons Army Medical
Center, Program Development Branch, ATTN: Mr. Graham Kolb, Aurora, CO
80045-6900.
FOR FURTHER INFORMATION CONTACT:
To request more information on this proposed information collection,
please write to the above address or call OCHAMPUS, Program
Requirements Branch at (303) 361-1180.
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/CHAMPUS to determine reimbursement for health care services or
supplies rendered by individual professional providers to TRICARE/
CHAMPUS beneficiaries. The requested information is used to determine
beneficiary eligibility, appropriateness and costs of care, other
health insurance liability and whether services received are benefits.
Use of this form continues TRICARE/CHAMPUS commitments to use the
national standard claim form for reimbursement of services/supplies
provided by individual professional providers.
AFFECTED PUBLIC: State and local governments, businesses or other for
profit organizations, Federal agencies and employees, non-profit
institutions, and small businesses or organizations.
Annual Burden Hours: 3,275,000
Number of Respondents: 13,100,000
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 health care providers
under 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 Uniformed Services members
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. The
Form 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/CHAMPUS beneficiaries. This is
the national standard claim form accepted by all major commercial and
government payers.
Dated: March 5, 1996.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 96-5554 Filed 3-7-96; 8:45 am]
BILLING CODE 5000-04-M
