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

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


### 25710 Federal Register / Vol. 77, No. 84 / Tuesday, May 1, 2012 / Notices

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. 2012–10394 Filed 4–30–12; 8:45 am]

**BILLING CODE 5001–06–P**

**DEPARTMENT OF DEFENSE**

**Office of the Secretary**

**[Docket ID: DOD–2010–HA–0133]**

**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 and OMB Number: Diagnosis Related Groups (DRG) Reimbursement; OMB Control Number 0720–0017.

Type of Request: Reinstatement. Number of Respondents: 4,993. Responses per Respondent: 1. Annual Responses: 4,993. Average Burden per Response: 1 hour. Annual Burden Hours: 4,993. 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 cost. Respondents are institutional providers.

Affected Public: Business or other forprofit; 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, Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 2012–10396 Filed 4–30–12; 8:45 am]

**BILLING CODE 5001–06–P**

**DEPARTMENT OF DEFENSE**

**Office of the Secretary**

**[Docket No. DOD–2010–HA–0132]**

**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 and OMB Number: TRICARE Retiree Dental Program Enrollment Application; OMB Control Number
0720–0015.

Type of Request: Reinstatement. Number of Respondents: 64,000. Responses per Respondent: 1. Annual Responses: 64,000. Average Burden per Response: 15 minutes.

Annual Burden Hours: 16,000. Needs and Uses: 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 TRICARE Retiree Dental Program 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. The information is provided by Uniformed Services members entitled to retired pay and their eligible family members who are seeking enrollment in the TRICARE Retiree Dental Program.

Affected Public: Individuals or households.

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. 2012–10395 Filed 4–30–12; 8:45 am]

**BILLING CODE 5001–06–P**

**DEPARTMENT OF ENERGY**

**Agency Information Collection Extension** 

**AGENCY :**  Department of Energy.