97-9871. Submission for OMB Review; Comment Request

[Federal Register Volume 62, Number 74 (Thursday, April 17, 1997)]
[Notices]
[Page 18761]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-9871]


-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary


Submission for OMB Review; Comment Request

ACTION: Notice.

-----------------------------------------------------------------------

    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 (44 U.S.C. Chapter 35).
    Title and Associated Form: Health Insurance Claim Form, HCFA Form 
1450, OMB Number 0720- [to be determined].
    Type of Request: New collection.
    Number of Respondents: 7,835.
    Responses per Respondent: 268 (average).
    Annual Responses: 2,100,000.
    Average Burden per Response: 15 minutes.
    Annual Burden Hours: 525,000.
    Needs and Uses: This collection of information is necessary for a 
medical institution to claim benefits under the 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 institutional providers.
    Affected Public: Individuals or households, business or other for-
profit, not-for-profit institutions.
    Frequency: On occasion.
    Respondents Obligation: Required to obtain or retain benefits.
    OMB Desk Officer: Ms. Allison Eydt.
    Written comments and recommendations on the proposed information 
collection should be sent to Ms. Eydt at the Office of Management and 
Budget, Desk Officer for DoD, Room 10235, New Executive Office 
Building, Washington, DC 20503.
    DOD Clearance Officer: Mr. Robert Cushing.
    Written requests for copies of the information collection proposal 
should be sent to Mr. Cushing, WHS/DIOR, 1215 Jefferson Davis Highway, 
Suite 1204, Arlington, VA 22202-4302.

    Dated: April 11, 1997.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 97-9871 Filed 4-16-97; 8:45 am]
BILLING CODE 5000-04-M