81242 Federal Register / Vol. 75, No. 247 / Monday, December 27, 2010 / Notices 

Attn; John J.M. Leininger, Aurora, CO 

80011–9066 or call TRICARE 

Management Activity—Aurora, 

Performance Evaluation and Transition 

Management Branch, at (303) 676–3613. 

Title, Associated Form and OMB 

Number: Health Insurance Claim Form, 

CMS–1500, OMB Control Number 

0720–0001. 

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’s 

commitment to use the national 

standard claim form for reimbursement 

of services/supplies provided by 

individual professional providers. 

Affected Public: Business or other for 

profit institutions, not-for-profit 

institutions, Federal government, state, 

local or tribal government. 

Annual Burden Hours: 21,500,000. 

Number of Respondents: 86,000,000. 

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 

TRICARE Program. TRICARE is a health 

benefits entitlement program for active 

duty, the dependents of active duty 

Uniformed Services members and 

deceased sponsors, retirees and their 

dependents, dependents of Department 

of Homeland Security (Coast Guard) 

sponsors, and certain North Atlantic 

Treaty Organizations, National Oceanic 

and Atmospheric Administration, and 

Public Health Service eligible 

beneficiaries. The CMS–1500 Form 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 form accepted 

by all major commercial and 

government payers. 

Dated: December 20, 2010. 

Morgan F. Park, 

Alternate OSD Federal Register Liaison 

Officer, Department of Defense. 

[FR Doc. 2010–32393 Filed 12–23–10; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

[Docket ID DOD–2010–HA–0177] 

Proposed Collection; Comment 

Request 

AGENCY: Office of the Assistant 

Secretary of Defense for Health Affairs, 

DoD. 

ACTION: Notice. 

SUMMARY: In compliance with Section 

3506(c)(2)(A) of the Paperwork 

Reduction Act of 1995, the Naval Health 

Research Center (NHRC), Department of 

the Navy, announces a new proposed 

public information collection and seeks 

public comment on the provisions 

thereof. Comments are invited on: (a) 

Whether the proposed 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 proposed 

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 by February 25, 

2011. 

ADDRESSES: You may submit comments, 

identified by docket number and title, 

by any of the following methods: 

• Federal eRulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

• Mail: Federal Docket Management 

System Office, Room 3C843, 1160 

Defense Pentagon, Washington, DC 

20301–1160. 

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. 

FOR FURTHER INFORMATION CONTACT: To 

request more information on this 

proposed information collection or to 

obtain a copy of the proposal and 

associated collection instruments, 

please write to: Commanding Officer, 

Naval Health Research Center, ATTN: 

Michael Galarneau, MS, NREMT, Code 

161, 140 Sylvester Road, San Diego, CA 

92106, or call at (619) 553–841 (this is 

not a toll-free number). 

Title; Associated Form; and OMB 

Number: Traumatic Brain Injury, PostTraumatic Stress Disorder, and LongTerm Quality of Life Outcomes in 

Injured Tri-Service U.S. Military 

Personnel; OMB Control Number 0720– 

TBD. 

Needs and Uses: The information 

collection requirement is necessary for 

the Naval Health Research Center 

(NHRC) to carry out the research study 

it has been tasked to perform. This 

research study will assess the long-term 

health impact of injury on quality of life 

outcomes in injured tri-service U.S. 

military personnel, with a special focus 

on the effects of traumatic brain injury 

(TBI) and Post-traumatic Stress Disorder 

(PTSD). 

Information collected will be used to 

investigate the long-term effects of 

injury, TBI, and PTSD on the overall 

physical and psychological health of 

military personnel injured in overseas 

contingency operations. Participants 

will respond to a health-related 

questionnaire bi-annually for three to 

six years. Respondents to this study will 

include both active-duty and separated 

members of all branches of the U.S. 

Armed Forces that have been injured 

and that have indicated a desire to 

participate through an Institutional 

Review Board (IRB)-approved informed 

consent process. 

Affected Public: Current and former 

members of the U.S. Armed Forces that 

have been injured in overseas 

contingency operations and that have 

indicated a desire to participate. 

Annual Burden Hours: 3,065 hours. 

Number of Respondents: Approx. 

4,644. 

Responses per Respondent: 2. 

Average Burden per Response: 20 

minutes. 

Frequency: Bi-annual. 

SUPPLEMENTARY INFORMATION: 

Summary of Information Collection 

This information collection is 

necessary for the Naval Health Research 

Center (NHRC) to carry out the research 

study ‘‘TRAUMATIC BRAIN INJURY, 

POST-TRAUMATIC STRESS 

DISORDER, AND LONG-TERM 

QUALITY OF LIFE OUTCOMES IN 

INJURED TRI-SERVICE U.S. MILITARY 

PERSONNEL.’’ NHRC has been tasked 

by the office of Congressionally Directed 

Medical Research Programs (CDMRP) to 

conduct this longitudinal 

epidemiological study. The NHRC team 

will collect information about physical 

and psychological health from members 

of the U.S. Armed Forces that have been 


erowe on DSK5CLS3C1PROD with NOTICES
Federal Register / Vol. 75, No. 247 / Monday, December 27, 2010 / Notices 81243 

injured in overseas contingency 

operations by administering a voluntary 

web, phone, or mail survey bi-annually 

for a period of three (3) to six (6) years. 

In all cases, informed consent will be 

obtained prior to survey administration. 

The information collected will be used 

to ascertain the long-term effects of 

traumatic brain injury (TBI), Posttraumatic Stress Disorder (PTSD), and 

other injuries on quality of life 

outcomes. Pinpointing the effects of 

these injuries will allow for the 

development of more effective 

treatments and early interventions in 

the management of TBI, PTSD, and 

other injuries sustained by U.S. military 

personnel in overseas contingency 

operations. 

Dated: December 20, 2010. 

Morgan F. Park, 

Alternate OSD Federal Register Liaison 

Officer, Department of Defense. 

[FR Doc. 2010–32392 Filed 12–23–10; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

[Docket ID DOD–2010–OS–0172] 

Proposed Collection; Comment 

Request 

AGENCY: Office of the Under Secretary of 

Defense (Personnel and Readiness), 

DoD. 

ACTION: Notice. 

SUMMARY: In compliance with Section 

3506(c)(2)(A) of the Paperwork 

Reduction Act of 1995, the Office of the 

Under Secretary of Defense (Personnel 

and Readiness) announces the following 

proposed public information collection 

and seeks public comment on the 

provisions thereof. Comments are 

invited on: (a) Whether the proposed 

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 burden of the 

proposed 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 the use of 

automated collection techniques or 

other forms of information technology. 

DATES: Consideration will be given to all 

comments received by February 25, 

2011. 

ADDRESSES: You may submit comments, 

identified by docket number and title, 

by any of the following methods: 

• Federal eRulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

• Mail: Federal Docket Management 

System Office, Room 3C843, 1160 

Defense Pentagon, Washington, DC 

20301–1160. 

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. 

FOR FURTHER INFORMATION CONTACT: To 

request more information on this 

proposed information collection or to 

obtain a copy of the proposal and 

associated collection instruments, 

please write to the Office of the Under 

Secretary of Defense (Personnel and 

Readiness), Department of Defense 

Education Activity, (Human Resources 

Regional Service Center, Staffing 

Section), ATTN: Ms. Patti Ross, 4040 

North Fairfax Drive, Arlington, VA 

22203, or call (703) 588–3915. 

Title, Associated Form, and OMB 

Control Number: Department of Defense 

Education Activity, Student Teacher 

Application, DoDEA Form 5308.1–F1, 

and OMB Number 0704–TBD. 

Needs and Uses: This information 

collection requirement, including the 

Social Security Number (SSN), will be 

used by security personnel for National 

Crime Information Center, State 

Criminal Histories, and Federal Bureau 

of Investigation record checks to 

determine eligibility to serve as a 

student teacher volunteer. The 

information will also be used to ensure 

that the student teacher is not in a pay 

status as a Department of Defense 

Education (DoDEA) employee at the 

time of the student teaching experience. 

Affected Public: Individuals or 

households. 

Annual Burden Hours: 50 hours. 

Number of Respondents: 150. 

Responses per Respondent: 1. 

Average Burden per Response: 20 

minutes. 

Frequency: One-time. Filling out a 

new application only occurs when a 

student teacher volunteer changes from 

one school to another school or if the 

student teacher volunteer has a 2-year 

break in school volunteer service. 

SUPPLEMENTARY INFORMATION: 

Summary of Information Collection 

The data collection is necessary to 

collect information from applicants for 

student teaching positions from which 

to determine eligibility for appointment 

as a student teacher volunteer. 

Information collection is necessary to 

determine if a student teacher applicant 

is suitable for a position involving 

extensive, frequent, or recurring 

unsupervised interaction with a student 

or students under the age of 18. The 

DoDEA Form 5308.1–F1, ‘‘Student 

Teacher Application,’’ records the name, 

SSN, address, phone numbers, and email address of the student teacher 

applicant. 

Dated: December 20, 2010. 

Morgan F. Park, 

Alternate OSD Federal Register Liaison 

Officer, Department of Defense. 

[FR Doc. 2010–32390 Filed 12–23–10; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

[Docket ID DOD–2010–OS–0173] 

Proposed Collection; Comment 

Request 

AGENCY: Office of the Under Secretary of 

Defense (Personnel and Readiness), 

DoD. 

ACTION: Notice. 

SUMMARY: In compliance with Section 

3506(c)(2)(A) of the Paperwork 

Reduction Act of 1995, the Office of the 

Under Secretary of Defense (Personnel 

and Readiness) announces the following 

proposed public information collection 

and seeks public comment on the 

provisions thereof. Comments are 

invited on: (a) Whether the proposed 

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 burden of the 

proposed 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 by February 25, 

2011. 

ADDRESSES: You may submit comments, 

identified by docket number and title, 

by any of the following methods: 


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