[Federal Register Volume 62, Number 51 (Monday, March 17, 1997)] [Notices] [Page 12608] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 97-6645] ----------------------------------------------------------------------- DEPARTMENT OF DEFENSE Office of the Secretary Proposed Collection; Comment Request agency: Office of the Assistant Secretary of Defense for Health Affairs. action: Notice. ----------------------------------------------------------------------- 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 a proposed uniform 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 on or before May 16, 1997. addresses: Written comments and recommendations on the proposed information collection should be sent to the Office of the Civilian Health and Medical Program of the Uniformed Services (OCHAMPUS), Fitzsimons U.S. Army Garrison, Program Development and Evaluation Directorate, ATTN: Mr. Joe Rhea, Aurora, CO 80045-6900. 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 the above address, or call OCHAMPUS, Program Development and Evaluation Directorate, at (303) 361-1018. Title, Associated Form, and OMB Number: TRICARE/CHAMPUS Provider Enrollment Application, HCFA-855, OMB Number 0938-0685. Needs and Uses: This information is needed to enroll health care providers not enrolled by Medicare by identifying them, verifying their qualifications and eligibility to participate in TRICARE/CHAMPUS, and to price and pay their claims correctly. Affected Public: Business or other for-profit; small businesses organizations, Federal Government. Annual Burden Hours: 105,000. Number of Respondents: 70,000. Responses per Respondent: 1. Average Burden per Response: 90 minutes. Frequency: Initial Application. supplementary information: Application is supported by photocopies of licensure, certification, and educational qualifications documents on a selected basis. Summary of Information Collection Respondents are health care providers who file claims seeking reimbursement directly or on behalf of eligible TRICARE/CHAMPUS beneficiaries for services and supplies which are authorized benefits of this health care program. The enrollment application and verification procedures will collect the information from providers needed to ensure that they can be uniquely identified and enumerated, and are qualified and eligible to participate in the TRICARE/CHAMPUS program. The use of the HCFA-855 Provider Enrollment Form makes uniform the information collection. Providers who have already been enrolled in Medicare will be required only to sign and submit the Form's certification statement and submit supplemental agreements for facsimile signatures and electronic claims submission which may remain specific and separate for Medicare and TRICARE/CHAMPUS. This application will implement the enrollment application for all TRICARE/ CHAMPUS providers/suppliers, and collect information necessary to issue the National Provider Identifier. The National Provider Identifier (NPI) will be assigned to all current providers and to all incoming providers as part of the enrollment process. Periodic Re-Verification of Provider Data will ensure that, once enrolled, all providers/ suppliers remain current under the Conditions of Enrollment. Dated: March 12, 1997. Patricia L. Toppings, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 97-6645 Filed 3-14-97; 8:45 am] BILLING CODE 5000-04-M