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###### Department of Defense

###### Office of the Secretary 

          - [No. DoD-2007-HA-0021] 

# AGENCY:

Office of the Assistant Secretary of Defense for Health Affairs, DoD. 

# ACTION:

Notice. 

                    In accordance with Section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office of the Assistant Secretary of Defense for Health Affairs announces the proposed extension of a currently approved collection and seeks public comment on the provisions thereof. Comments are invited on: (a) Whether the proposed extension of 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                           ( print page 10716)                        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 May 8, 2007. 

# 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, 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, please write to the TRICARE Management Activity—Aurora, Office of Program Requirements Division, 16401 E. Centretech Parkway, ATTN: John J.M. Leininger, Aurora, CO 80011-9066, or call TRICARE Management Activity, Office of Program Requirements Division 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 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.                     

*Annual Burden Hours:*                         6,000,000.                     

*Number of Respondents:*                         24,000,000.                     

*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 the dependents of active duty Uniformed Services member 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: March 2, 2007. 

Patricia L. Toppings, 

Alternate OSD Federal Register Liaison Officer, Department of Defense. 

[FR Doc. 07-1110 Filed 3-8-07; 8:45 am] 

BILLING CODE 5001-06-M