Document
Submission for OMB Review; Comment Request
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.
SUPPLEMENTARY INFORMATION:
Title; Associated Form; and OMB Number:
Professional Qualifications Medical/Peer Reviewers; CHAMPUS Form 780; OMB Control Number 0720-0005.
Type of Request:
Revision.
Number of Respondents:
60.
Responses per Respondent:
1.
Annual Responses:
60.
Average Burden per Response:
20 minutes.
Annual Burden Hours:
20.
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:
Businesses or other for-profit.
Frequency:
One-time collection.
Respondent's Obligation:
Voluntary.
OMB Desk Officer:
Mr. James Crowe.
You may also submit comments and recommendations, identified by Docket ID number and title, by the following method:
Instructions:
All submissions received must include the agency name, Docket ID 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. Angela James.
Requests for copies of the information collection proposal should be sent to Ms. James at
whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil.
Dated: February 18, 2021.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.