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

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-relatedgroups (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


### 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.