Diagnosis Related Groups (DRG) Reimbursement (Two Parts)

ICR 202203-0720-001

OMB: 0720-0017

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2022-03-28
IC Document Collections
ICR Details
0720-0017 202203-0720-001
Received in OIRA 201812-0720-001
DOD/DODOASHA 0720-0017
Diagnosis Related Groups (DRG) Reimbursement (Two Parts)
Revision of a currently approved collection   No
Regular 03/29/2022
  Requested Previously Approved
36 Months From Approved 03/31/2022
5,600 5,600
5,600 8,400
264,824 397,236

Hospitals subject to the TRICARE DRG-based payment system who wish to be reimbursed for Allowed Capital and Direct Medical Education costs (as outlined in the TRICARE Reimbursement Manual) must submit a request for reimbursement to the appropriate TRICARE/CHAMPUS authorized contractors of Managed Care Support Contracts.

PL: Pub.L. 98 - 94 1079(j)(2)(A) Name of Law: The Department of Defense Authorization Act,
  
None

Not associated with rulemaking

  87 FR 3781 01/25/2022
87 FR 17279 03/28/2022
No

1
IC Title Form No. Form Name
Diagnosis Related Groups (DRG) Reimbursement (Two Parts)

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,600 5,600 0 0 0 0
Annual Time Burden (Hours) 5,600 8,400 0 -2,800 0 0
Annual Cost Burden (Dollars) 264,824 397,236 0 -132,412 0 0
No
Yes
Miscellaneous Actions
The burden has decreased due to a more accurate calculation of the response time.

$6,764
No
    No
    No
No
No
No
No
Sandra Dennis 703 681-8818 sandra.e.dennis4.ctr@mail.mil

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/29/2022


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