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###### Department of Defense

###### Office of the Secretary

          - [Docket No. DOD-2010-HA-0175]

# 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).

# DATES:

Consideration will be given to all comments received by May 31, 2012.

*Title, Associated Form and OMB Number:*                         Health Insurance Claim Form, CMS-1500; OMB Control Number 0720-0001.                    

*Type of Request:*                         Reinstatement.                    

*Number of Respondents:*                         86,000,000.                    

*Responses per Respondent:*                         1.                    

*Annual Responses:*                         86,000,000.                    

*Average Burden per Response:*                         15 minutes.                    

*Annual Burden Hours:*                         21,500,000 hours.                    

*Needs and Uses:*                         This information collection requirement is used by TRICARE to determine reimbursement for health care services or supplies rendered by individual professional providers to TRICARE 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 commitments to use the national standard claim form for reimbursement of services/supplies provided by individual professional providers.                    

*Affected Public:*                         Business or other for-profit; not-for-profit institutions; Federal government; state, local or tribal government.                    

*Frequency:*                         On occasion.                    

*Respondent's Obligation:*                         Required to obtain or retain benefits.                    

*OMB Desk Officer:*                         Mr. John Kraemer.                    

Written comments and recommendations on the proposed information collection should be sent to Mr. Kraemer at the Office of Management and Budget, Desk Officer for DoD, Room 10236, New Executive Office Building, Washington, DC 20503.

You may also submit comments, identified by docket 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 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:*                         Ms. Patricia Toppings.                    

Written requests for copies of the information collection proposal should be sent to Ms. Toppings at WHS/ESD/Information Management Division, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100.

Dated: February 15, 2012.

Patricia L. Toppings,

OSD Federal Register Liaison Officer, Department of Defense.

[FR Doc. 2012-10393 Filed 4-30-12; 8:45 am]

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