### 81241 Federal Register / Vol. 75, No. 247 / Monday, December 27, 2010 / Notices

**DEPARTMENT OF DEFENSE**

**Office of the Secretary**

**[Docket ID DOD–2010–HA–0176]**

**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 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 Appeals, Hearings and Claims Collection Division, Office of General Counsel, TRICARE ® Management Activity, Attn: Mark P. Donahue, 16401 East Centretech Parkway, Aurora, CO 80011–9066, or via telephone at (303) 676–3411.

Title; Associated Form; and OMB Number: Professional Qualifications Medical/Peer Reviewers, CHAMPUS Form 780, OMB Number 0720–0005.

Needs and Uses: The information collection requirement is necessary to obtain and record the professional qualifications of medical and peer reviewers utilized within TRICARE ®

. The form is included as an exhibit in an appeal or hearing case file as evidence of the reviewer’s professional qualifications to review the medical documentation contained in the case file.

Affected Public: Business or other for profit.

Annual Burden Hours: 20. Number of Respondents: 60. Responses per Respondent: 1. Average Burden per Response: 20 minutes.

Frequency: On occasion.

**SUPPLEMENTARY INFORMATION :**  Summary of Information Collection

Respondents are medical professionals who provide medical and peer review of cases appealed to the Appeals, Hearings and Claims Collection Division, Office of General Counsel, TRICARE ® Management Activity. CHAMPUS Form 780 records the professional qualifications of the medical or peer reviewer. The completed form is included as an exhibit in the appeal or hearing case file to document the professional qualifications of the medical professional who reviewed the case. If the form is not included in the case file, individuals reviewing the file cannot confirm the qualifications of the reviewing medical professional. Having qualified professionals provide medical and peer review is essential in maintaining the integrity of the appeal and hearing process.

Dated: December 20, 2010. Morgan F. Park, Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2010–32394 Filed 12–23–10; 8:45 am]

**BILLING CODE 5001–06–P DEPARTMENT OF DEFENSE** 

**Office of the Secretary**

**[Docket ID DOD–2010–OS–0175]**

**Proposed Collection; Comment Request** 

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

**ACTION :**  Notice.

**SUMMARY :**  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 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 document 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, please write to the TRICARE Management Activity—Aurora, Performance Evaluation and Transition Management Branch, 16401 E. Centretech Parkway,


### 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