Federal Register / Vol. 75, No. 189 / Thursday, September 30, 2010 / Notices 60417 

reasonable value of medical care 

provided by the United States to a 

person who is injured or suffers a 

disease under circumstances creating 

tort liability in a third person. DD Form 

2527 is required for investigating and 

asserting claims in favor of the United 

States arising out of such incidents. 

When a claim for TRICARE benefits is 

identified as involving possible third 

party liability and the information is not 

submitted with the claim, the TRICARE 

contractor requests that the injured 

party (or a designee) complete DD Form 

2527. To protect the interests of the 

Government, the contractor suspends 

claims processing until the requested 

third party liability information is 

received. The contractor conducts a 

preliminary evaluation based upon the 

collection of information and refers the 

case to a designated appropriate legal 

officer of the Uniformed Services. The 

responsible Uniformed Services legal 

officer uses the information as a basis 

for asserting and settling the 

Government’s claim. When appropriate, 

the information is forwarded to the 

Department of Justice as the basis for 

litigation. 

Section 1 of the Form is used to 

collect general information, such as 

name, address and telephone numbers 

about the military sponsor and the 

injured beneficiary and the date, time 

and location where the injured 

occurred. 

Section 2 of the Form is used to 

collect information about accidental 

injuries. Most of the investigations for 

third party liability involve motor 

vehicle accidents. Information about 

insurance coverage for the parties 

involved in the accident is collected. 

Section 2 of the Form is also used to 

collect information about accidents not 

involving motor vehicles. Information 

such as the type of accident, the place 

where the injury occurred, the name of 

the property owner where the injury 

occurred and cause of the injury is 

collected. The name and address of the 

employer is collected when the injury 

was work related. 

Section 3 of the Form is used for 

miscellaneous information such as 

possible medical treatment at a 

Government hospital, the name and 

address of the beneficiary’s attorney, 

and information regarding any possible 

releases or settlements with another 

party to the accident. It also contains the 

certification, date and signature of the 

beneficiary (or a designee). 

Dated: September 17, 2010. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. 2010–24529 Filed 9–29–10; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

[Docket ID: DoD–2010–HA–0133] 

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 Office of the 

Assistant Secretary of Defense for 

Health Affairs announces the proposed 

extension of a 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 November 29, 

2010. 

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, 

Room 3C843, 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 TRICARE 

Management Activity, Medical Benefits 

and Reimbursement Branch, Ann N. 

Fazzini, Aurora, CO 80011 or phone 

303–676–3803. 

Title; Associated Form; and OMB 

Number: Diagnosis Related Groups 

(DRG) Reimbursement; OMB Control 

Number 0720–0017. 

Needs and Uses: The TRICARE/ 

CHAMPUS contractors will use the 

information collected to reimburse 

hospitals for TRICARE/CHAMPUS share 

of capital and direct medical education 

costs. Respondents are institutional 

providers. 

Affected Public: Business or other forprofit. 

Annual Burden Hours: 4,993. 

Number of Respondents: 4,993. 

Responses per Respondent: 1. 

Average Burden per Response: 1 hour. 

Frequency: On occasion. 

SUPPLEMENTARY INFORMATION: 

Summary of Information Collection 

The Department of Defense 

Authorization Act, 1984, Public Law 

98–94 amended Title 10, section 

1079(j)(2)(A) of the U.S.C. and provided 

the Civilian Health and Medical 

Program of the Uniform Services 

(CHAMPUS) with the statutory 

authority to reimburse institutional 

providers based on diagnosis-related 

groups (DRGs). The CHAMPUS DRGbased payment system, except for 

children’s hospitals (whose capital and 

direct medical education costs are 

incorporated in the children’s hospital 

differential), who want to be reimbursed 

for allowed capital and direct medical 

education costs must submit a request 

for payment to the TRICARE/CHAMPUS 

contractor. The request allows TRICARE 

to collect the information necessary to 

properly reimburse hospitals for its 

share of these costs. The information 

can be submitted in any form, most 

likely in the form of a letter. The 

contractor will calculate the TRICARE/ 

CHAMPUS share of capital and direct 

medical educations costs and make a 

lump-sum payment to the hospital. The 

TRICARE/CHAMPUS DRG-based 

payment system is modeled on the 

Medicare Prospective Payment System 

(PPS) and was implemented on October 

1, 1987. Initially, under 42 CFR 412.46 

of the Medicare regulations, physicians 

were required to sign attestation and 

acknowledgment statements. These 

requirements were implemented to 

ensure a means of holding hospitals and 

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60418 Federal Register / Vol. 75, No. 189 / Thursday, September 30, 2010 / Notices 

physicians accountable for the 

information they submit on the 

Medicare claim forms. Being modeled 

on the Medicare PPS, CHAMPUS also 

adopted these requirements. The 

physicians attestation and physician 

acknowledgment required by Medicare 

under 42 CFR 412.46 are also required 

for CHAMPUS as a condition for 

payment and may be satisfied by the 

same statements as required for 

Medicare, with substitution or addition 

of ‘‘CHAMPUS’’ when the word 

‘‘Medicare’’ is used. Physicians sign a 

physician acknowledgement, 

maintained by the institution, at the 

time the physician is granted admitting 

privileges. This acknowledgement 

indicates the physician understands the 

importance of a correct medical record, 

and misrepresentation may be subject to 

penalties. 

Dated: September 10, 2010. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. 2010–24530 Filed 9–29–10; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

[Docket ID: DoD–2010–HA–0132] 

Proposed Collection; Comment 

Request 

AGENCY: Office of the Assistant 

Secretary of Defense for Health Affairs, 

DoD. 

ACTION: Notice. 

In compliance 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 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 November 29, 

2010. 

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, 

Room 3C843, 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 TRICARE Management 

Activity, Contract Operations Branch, 

16401 E. Centretech Parkway, Attn: 

Kenneth Zimmerman, Aurora, CO 

80011, or call TRICARE Management 

Activity, Contract Operations Branch, at 

(303–676–3502). 

Title; Associated Form; and OMB 

Number: TRICARE Retiree Dental 

Program Enrollment Application Form; 

OMB Number 0720–0015. 

Needs and Uses: This information 

collection is completed by Uniformed 

Services members entitled to retired pay 

and their eligible family members who 

are seeking enrollment in the TRICARE 

Retiree Dental Program (TRDP). The 

information is necessary to enable the 

DoD-contracted third party 

administrator of the program to identify 

the program’s applicants, determine 

their eligibility for TRDP enrollment, 

establish the premium payment amount, 

and to verify by the applicant’s 

signature that the applicant understands 

the benefits and rules of the program. 

Affected Public: Individuals or 

household. 

Annual Burden Hours: 17,833. 

Number of Respondents: 71,332. 

Responses Per Respondent: 1. 

Average Burden Per Response: 15 

minutes. 

Frequency: Annually. 

SUPPLEMENTARY INFORMATION: 

Summary of Information Collection 

The TRICARE Retiree Dental Program 

(32 CFR 199.22) was implemented in 

1998 based on the authority of 10 U.S.C. 

1076c. Dental coverage under the 

program is available on a voluntary 

basis to retirees of the Uniformed 

Services entitled to retired pay and their 

family members. 

The information collection 

requirements under this proposed 

extension are similar to those under the 

current collection. Information on the 

applicant, such as name, address, 

telephone numbers, date of birth, and 

retiree’s social security number, is 

necessary for identification purposes, as 

is information on the family members to 

be enrolled. The form also contains 

information on premium payment 

enrollment options and a certification 

statement for the applicant to sign and 

date. The primary change in the 

proposed extension of the information 

collection is to update the expiration 

date of the Enrollment Application. 

Dated: September 10, 2010. 

Patricia L. Toppings, 

OSD Federal Register Liaison Officer, 

Department of Defense. 

[FR Doc. 2010–24531 Filed 9–29–10; 8:45 am] 

BILLING CODE 5001–06–P 

DEPARTMENT OF DEFENSE 

Office of the Secretary 

[Docket ID: DoD–2010–HA–0134] 

Proposed Collection; Comment 

Request 

AGENCY: Uniformed Services University 

of the Health Sciences, Graduate School 

of Nursing, DoD. 

ACTION: Notice. 

SUMMARY: In compliance with Section 

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

Reduction Act of 1995, the Uniformed 

Services University of the Health 

Sciences proposes a new public 

information collection. 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 November 29, 

2010. 

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