Proposed Collection; Comment Request, 81241-81242 [2010-32393]
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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
Office of the Assistant
Secretary of Defense for Health Affairs,
DoD.
ACTION: Notice.
AGENCY:
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.
SUMMARY:
You may submit comments,
identified by docket number and title,
by any of the following methods:
• Federal eRulemaking Portal: https://
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 https://
www.regulations.gov as they are
received without change, including any
personal identifiers or contact
information.
erowe on DSK5CLS3C1PROD with NOTICES
ADDRESSES:
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
FOR FURTHER INFORMATION CONTACT:
VerDate Mar<15>2010
15:15 Dec 23, 2010
Jkt 223001
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]
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81241
DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket ID DOD–2010–OS–0175]
Proposed Collection; Comment
Request
Office of the Assistant
Secretary of Defense for Health Affairs,
DoD.
ACTION: Notice.
AGENCY:
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.
SUMMARY:
You may submit comments,
identified by document number and
title by any of the following methods:
• Federal eRulemaking Portal: https://
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 https://
www.regulations.gov as they are
received without change, including any
personal identifiers or contact
information.
ADDRESSES:
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,
FOR FURTHER INFORMATION CONTACT:
E:\FR\FM\27DEN1.SGM
27DEN1
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:
erowe on DSK5CLS3C1PROD with NOTICES
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
VerDate Mar<15>2010
15:15 Dec 23, 2010
Jkt 223001
DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket ID DOD–2010–HA–0177]
Proposed Collection; Comment
Request
Office of the Assistant
Secretary of Defense for Health Affairs,
DoD.
ACTION: Notice.
AGENCY:
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.
SUMMARY:
You may submit comments,
identified by docket number and title,
by any of the following methods:
• Federal eRulemaking Portal: https://
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 https://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
ADDRESSES:
PO 00000
Frm 00039
Fmt 4703
Sfmt 4703
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
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]]>Agencies
[Federal Register Volume 75, Number 247 (Monday, December 27, 2010)]
[Notices]
[Pages 81241-81242]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-32393]
-----------------------------------------------------------------------
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: https://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 https://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,
[[Page 81242]]
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
