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[Federal Register Volume 77, Number 84 (Tuesday, May 1, 2012)]
[Notices]
[Page 25709]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-10393]

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DEPARTMENT OF DEFENSE

Office of the Secretary

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

Submission for OMB Review; Comment Request

ACTION: Notice.

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    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]
BILLING CODE 5001-06-P
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