Proposed Collection; Comment Request
| Published date | 24 August 2021 |
| Citation | 86 FR 47302 |
| Record Number | 2021-18133 |
| Section | Notices |
| Court | Defense Department |
Federal Register, Volume 86 Issue 161 (Tuesday, August 24, 2021)
[Federal Register Volume 86, Number 161 (Tuesday, August 24, 2021)]
[Notices]
[Page 47302]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-18133]
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DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket ID: DoD-2021-HA-0087]
Proposed Collection; Comment Request
AGENCY: The Office of the Assistant Secretary of Defense for Health
Affairs, Department of Defense (DoD).
ACTION: Information collection notice.
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SUMMARY: In compliance with the Paperwork Reduction Act of 1995, the
Defense Health Agency announces a proposed public information
collection and seeks public comment on the provisions thereof. Comments
are invited on: 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; the
accuracy of the agency's estimate of the burden of the proposed
information collection; ways to enhance the quality, utility, and
clarity of the information to be collected; and 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 October
25, 2021.
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: DoD cannot receive written comments at this time due to the
COVID-19 pandemic. Comments should be sent electronically to the docket
listed above.
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.
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 Defense Health
Agency, ATTN: Zelly Zim, 8111 Gatehouse Road, 229D, Falls Church, VA
22042 or call 571-232-1551.
SUPPLEMENTARY INFORMATION:
Title; Associated Form; and OMB Number: TriCare DoD/CHAMPUS Medical
Claim Patient's Request for Medical Payment; DD Form 2642; OMB Control
Number 0720-0006.
Needs and Uses: The DD-2642, ``TRICARE DoD/CHAMPUS Medical Claim
Patient's Request for Medical Payment'' form is used by TRICARE
beneficiaries to claim reimbursement for medical expenses under the
TRICARE Program (formerly the Civilian Health and Medical Program of
the Uniformed Services (CHAMPUS)). The information collected will be
used by TRICARE to determine beneficiary eligibility, other health
insurance liability, certification that the beneficiary has the
received care, and reimbursement for medical services received.
Affected Public: Individuals or households.
Annual Burden Hours: 207,500.
Number of Respondents: 830,000.
Responses per Respondent: 1.
Annual Responses: 830,000.
Average Burden per Response: 15 minutes.
Frequency: As required.
Dated: August 17, 2021.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2021-18133 Filed 8-23-21; 8:45 am]
BILLING CODE 5001-06-P
