[Federal Register Volume 64, Number 68 (Friday, April 9, 1999)]
[Notices]
[Page 17350]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-8799]
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DEPARTMENT OF DEFENSE
Office of the Secretary
Proposed Collection; Comment Request
AGENCY: Office of the Assistant Secretary of Defense for Health
Affairs.
ACTION: Notice.
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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 June 8,
1999.
ADDRESSES: Written comments and recommendations on the information
collection should be sent to TRICARE Management Activity--Aurora,
Office of Program Requirements, 16401 E. Centretech Parkway, ATTN:
Graham Kolb, Aurora, CO 80011-9043.
FOR FURTHER INFORMATION CONTACT: To request more information on this
proposed information collection, please write to the above address or
call TRICARE Management Activity, Program Requirements Branch at (303)
676-3580.
Title, Associated Form, and OMB Number: CHAMPUS Claim Patient's
Request for Medical Payment, DD Form 2642, OMB Number 0720-0006.
Needs and Uses: This form is used solely by beneficiaries claiming
reimbursement for medical expenses under the TRICARE Program [formerly
the Civilian Health and Medical Program of the Uniformed Services
(TRICARE/CHAMPUS)]. The information collected will be used by TRICARE/
CHAMPUS to determine beneficiary eligibility, other health insurance
liability, certification that the beneficiary received the care, and
reimbursement for the medical services received.
Affected Public: Individual or households.
Annual Burden Hours: 239,000.
Number of Respondents: 956,000.
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 beneficiaries under the
TRICARE Program [formerly the Civilian Health and Medical Program of
the Uniformed Services (TRICARE/CHAMPUS)]. TRICARE/CHAMPUS is a health
benefits entitlement program for the dependents of active duty Uniform
Services members and deceased sponsors, retirees and their dependents,
dependents of Department of Transportation (Coast Guard) sponsors, and
certain North Atlantic Treaty Organizations, National Oceanic and
Atmospheric Administration, and Public Health Service eligible
beneficiaries. DD Form 2642 is used solely by TRICARE/CHAMPUS
beneficiaries to file for reimbursement of costs paid to provider and
suppliers for authorized health care services or supplies.
Dated: April 5, 1999.
L.M. Bynum,
Alternate OSD, Federal Register Liaison Officer, Department of Defense.
[FR Doc. 99-8799 Filed 4-8-99; 8:45 am]
BILLING CODE 5001-10-M
