Federal Register / Vol. 77, No. 84 / Tuesday, May 1, 2012 / Notices 25709 

to apply for Corporate Services Provider 

status under the TRICARE program. 

Affected Public: Businesses or other 

for-profit; not-for-profit institutions. 

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. 2012–10397 Filed 4–30–12; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

[Docket No. DOD–2010–HA–0175] 

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). 

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 forprofit; 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 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

[Docket No. DOD–2010–HA–0131] 

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). 

DATES: Consideration will be given to all 

comments received by May 31, 2012. 

Title, Associated Form and OMB 

Number: Statement of Personal Injury— 

Possible Third Party Liability, TRICARE 

Management Activity; DD Form 2527; 

OMB Control Number 0720–0003. 

Type of Request: Reinstatement. 

Number of Respondents: 224,399. 

Responses per Respondent: 1. 

Annual Responses: 224,399. 

Average Burden per Response: 15 

minutes. 

Annual Burden Hours: 56,100 hours. 

Needs and Uses: The information is 

provided by TRICARE (formerly 

CHAMPUS) beneficiaries suffering from 

personal injuries and receiving medical 

care at Government expense. The 

information is necessary in the assertion 

of the Government’s right to recovery 

under the Federal Medical Care 

Recovery Act. The data is used in the 

evaluation and processing of these 

claims. 

Affected Public: Individuals or 

households; Federal 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 

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