81 FR 32736 - Proposed Collection; Comment Request

DEPARTMENT OF DEFENSE
Office of the Secretary

Federal Register Volume 81, Issue 100 (May 24, 2016)

Page Range		32736-32736
FR Document		2016-12217

In compliance with the Paperwork Reduction Act of 1995, the Office of the Assistant Secretary of Defense for Health Affairs announces a 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.

Federal Register, Volume 81 Issue 100 (Tuesday, May 24, 2016)

[Federal Register Volume 81, Number 100 (Tuesday, May 24, 2016)]
[Notices]
[Page 32736]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-12217]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID: DOD-2015-HA-0008]


Proposed Collection; Comment Request

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

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act of 1995, the 
Office of the Assistant Secretary of Defense for Health Affairs 
announces a 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 July 25, 
2016.

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: Department of Defense, Office of the Deputy Chief 
Management Officer, Directorate for Oversight and Compliance, 4800 Mark 
Center Drive, Mailbox #24, Alexandria, VA 22350-1700.
    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.
    Any associated form(s) for this collection may be located within 
this same electronic docket and downloaded for review/testing. Follow 
the instructions at http://www.regulations.gov for submitting comments. 
Please submit comments on any given form identified by docket number, 
form number, and title.

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 Defense Health 
Agency, Performance Evaluation & Transition Management Branch, ATTN: 
Ann Fazzini, 16401 E. Centretech Parkway, Aurora, CO 80011-9066, 
telephone 303-676-3613.

SUPPLEMENTARY INFORMATION: 
    Title; Associated Form; and OMB Number: Health Insurance Claim 
Form, UB-04 CMS.1450, OMB Control Number 0720-0013.
    Needs and Uses: The information collection requirement is necessary 
for a medical institution to claim benefits under the Defense Health 
Program, TRICARE which includes the Civilian Health and Medical Program 
for the Uniformed Services (CHAMPUS). The information collected will be 
used by TRICARE/CHAMPUS to determine beneficiary eligibility, other 
health insurance liability, certification that the beneficiary received 
the care, and that the provider is authorized to receive TRICARE/
CHAMPUS payments. The form will be used by TRICARE/CHAMPUS and its 
contractors to determine the amount of benefits to be paid by TRICARE/
CHAMPUS to institutional providers.
    Affected Public: Business or other for profit; Not-for-profit 
institutions.
    Annual Burden Hours: 135,000.
    Number of Respondents: 540,000.
    Responses per Respondent: 1.
    Annual Responses: 540,000.
    Average Burden per Response: 15 minutes.
    Frequency: On occasion.
    This collection instrument is for use by medical institutions 
filing for reimbursement with the Defense Health Program, TRICARE, 
which includes the Civilian Health and Medical Program of the Uniformed 
Services (TRICARE/CHAMPUS). TRICARE/CHAMPUS is a health benefits 
entitlement program for the dependents of active duty members of the 
Uniformed Services, and deceased sponsors, retirees and their 
dependents, of the Department of Homeland Security (Coast Guard) 
sponsors and certain North Atlantic Treaty Organization, National 
Oceanic and Atmospheric Administration, and Public Health Service 
eligible beneficiaries. Use of the UB-04/CMS-1450 continues TRICARE/
CHAMPUS commitments to use the national standard claim form for 
reimbursement of medical services/supplies provided by institutional 
providers.

    Dated: May 19, 2016.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2016-12217 Filed 5-23-16; 8:45 am]
 BILLING CODE 5001-06-P

32736 Federal Register / Vol. 81, No. 100 / Tuesday, May 24, 2016 / Notices

provided to or considered by the BoV for the proper performance of the TRICARE which includes the Civilian
until its next open meeting. The DFO functions of the agency, including Health and Medical Program for the
will review all timely submissions with whether the information shall have Uniformed Services (CHAMPUS). The
the BoV Chairman and ensure they are practical utility; (b) the accuracy of the information collected will be used by
provided to members of the BoV before agency’s estimate of the burden of the TRICARE/CHAMPUS to determine
the meeting that is the subject of this proposed information collection; (c) beneficiary eligibility, other health
notice. If after review of timely ways to enhance the quality, utility, and insurance liability, certification that the
submitted written comments and the clarity of the information to be beneficiary received the care, and that
BoV Chairman and DFO deem collected; and (d) ways to minimize the the provider is authorized to receive
appropriate, they may choose to invite burden of the information collection on TRICARE/CHAMPUS payments. The
the submitter of the written comments respondents, including through the use form will be used by TRICARE/
to orally present the issue during an of automated collection techniques or CHAMPUS and its contractors to
open portion of the BoV meeting that is other forms of information technology. determine the amount of benefits to be
the subject of this notice. Members of DATES: Consideration will be given to all paid by TRICARE/CHAMPUS to
the BoV may also petition the Chairman comments received by July 25, 2016. institutional providers.
to allow specific personnel to make oral ADDRESSES: You may submit comments, Affected Public: Business or other for
presentations before the BoV. In identified by docket number and title, profit; Not-for-profit institutions.
accordance with 41 CFR Section 102– by any of the following methods: Annual Burden Hours: 135,000.
3.140(d), any oral presentations before • Federal eRulemaking Portal: http:// Number of Respondents: 540,000.
the BoV shall be in accordance with Responses per Respondent: 1.
www.regulations.gov. Follow the
agency guidelines provided pursuant to Annual Responses: 540,000.
instructions for submitting comments. Average Burden per Response: 15
a written invitation and this paragraph. • Mail: Department of Defense, Office
Direct questioning of BoV members or minutes.
of the Deputy Chief Management Frequency: On occasion.
meeting participants by the public is not Officer, Directorate for Oversight and This collection instrument is for use
permitted except with the approval of Compliance, 4800 Mark Center Drive, by medical institutions filing for
the DFO and Chairman. For the benefit Mailbox #24, Alexandria, VA 22350– reimbursement with the Defense Health
of the public, rosters that list the names 1700. Program, TRICARE, which includes the
of BoV members and any releasable Instructions: All submissions received Civilian Health and Medical Program of
materials presented during the open must include the agency name, docket the Uniformed Services (TRICARE/
portions of this BoV meeting shall be number and title for this Federal CHAMPUS). TRICARE/CHAMPUS is a
made available upon request. Register document. The general policy health benefits entitlement program for
FOR FURTHER INFORMATION CONTACT: For for comments and other submissions the dependents of active duty members
additional information or to attend this from members of the public is to make of the Uniformed Services, and
BoV meeting, contact Lt Col Veronica these submissions available for public deceased sponsors, retirees and their
Senia, Chief, Officer Accessions and viewing on the Internet at http:// dependents, of the Department of
Training, AF/A1PT, 1040 Air Force www.regulations.gov as they are Homeland Security (Coast Guard)
Pentagon, Washington, DC 20330, (703) received without change, including any sponsors and certain North Atlantic
692–5577, Veronica.V.Senia.mil@ personal identifiers or contact Treaty Organization, National Oceanic
mail.mil. information. and Atmospheric Administration, and
Any associated form(s) for this
Henry Williams, Public Health Service eligible
collection may be located within this
Acting Air Force Federal Register Liaison beneficiaries. Use of the UB–04/CMS–
same electronic docket and downloaded
Officer. 1450 continues TRICARE/CHAMPUS
for review/testing. Follow the
[FR Doc. 2016–12165 Filed 5–23–16; 8:45 am] commitments to use the national
instructions at http://
standard claim form for reimbursement
BILLING CODE 5001–10–P www.regulations.gov for submitting
of medical services/supplies provided
comments. Please submit comments on
by institutional providers.
any given form identified by docket
DEPARTMENT OF DEFENSE number, form number, and title. Dated: May 19, 2016.
FOR FURTHER INFORMATION CONTACT: To Aaron Siegel,
Office of the Secretary
request more information on this Alternate OSD Federal Register Liaison
[Docket ID: DOD–2015–HA–0008] proposed information collection or to Officer, Department of Defense.
obtain a copy of the proposal and [FR Doc. 2016–12217 Filed 5–23–16; 8:45 am]
Proposed Collection; Comment associated collection instruments, BILLING CODE 5001–06–P
Request please write to Defense Health Agency,
AGENCY: Office of the Assistant Performance Evaluation & Transition
Secretary of Defense for Health Affairs, Management Branch, ATTN: Ann DEPARTMENT OF DEFENSE
DoD. Fazzini, 16401 E. Centretech Parkway,
Aurora, CO 80011–9066, telephone 303– Office of the Secretary
ACTION: Notice.
676–3613. [Docket ID: DOD–2016–OS–0062]
SUMMARY: In compliance with the SUPPLEMENTARY INFORMATION:
Paperwork Reduction Act of 1995, the Title; Associated Form; and OMB Proposed Collection; Comment
sradovich on DSK3TPTVN1PROD with NOTICES

Office of the Assistant Secretary of Number: Health Insurance Claim Form, Request
Defense for Health Affairs announces a UB–04 CMS.1450, OMB Control AGENCY: Office of the Assistant
proposed public information collection Number 0720–0013. Secretary of Defense for Acquisition
and seeks public comment on the Needs and Uses: The information Technology and Logistics (Program
provisions thereof. Comments are collection requirement is necessary for a Support), DoD.
invited on: (a) Whether the proposed medical institution to claim benefits
ACTION: Notice.
collection of information is necessary under the Defense Health Program,

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Document Created: 2016-05-24 05:21:20
Document Modified: 2016-05-24 05:21:20

Category		Regulatory Information
Collection		Federal Register
sudoc Class		AE 2.7: GS 4.107: AE 2.106:
Publisher		Office of the Federal Register, National Archives and Records Administration
Section		Notices
Action		Notice.
Dates		Consideration will be given to all comments received by July 25, 2016.
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 Defense Health Agency, Performance Evaluation & Transition Management Branch, ATTN: Ann Fazzini, 16401 E. Centretech Parkway, Aurora, CO 80011-9066, telephone 303-676-3613.
FR Citation		81 FR 32736

81 FR 32736 - Proposed Collection; Comment Request

DEPARTMENT OF DEFENSEOffice of the Secretary

Federal Register Volume 81, Issue 100 (May 24, 2016)

DEPARTMENT OF DEFENSE
Office of the Secretary