95-17114. Public Information Collection Requirement Submitted to the Office of Management and Budget (OMB) for Review

[Federal Register Volume 60, Number 134 (Thursday, July 13, 1995)]
[Notices]
[Pages 36108-36109]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-17114]



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DEPARTMENT OF DEFENSE


Public Information Collection Requirement Submitted to the Office 
of Management and Budget (OMB) for Review

ACTION: Notice.

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    The Department of Defense has submitted to OMB for clearance, the 
following proposal for collection of information under the provisions 
of the Paperwork Reduction Act (44 U.S.C. Chapter 35).
    Title: TRICARE Enrollment Application Form.
    Type of Request: Expedited Processing--Approval date requested: 30 
days following publication in the Federal Register.
    Number of Respondents: 300,000.
    Responses Per Respondent: 1.
    Annual Responses: 300,000.
    Average Burden Per Response: 15 minutes.
    Annual Burden Hours: 75,000.
    Needs and Uses: The collection instrument serves as an application 
form for enrollment in the TRICARE Health Care Delivery Program 
established in accordance with 10 USC 

[[Page 36109]]
1099. The information collected hereby, provides the private Third 
Party Administrator, contracted to provide administrative support 
services, with necessary data to determine beneficiary eligibility, 
other health insurance liability, premium payment, and to identify 
selection of health care option.
    Affected Public: Individuals or households.
    Frequency: Annually.
    Respondent's Obligation: Voluntary.
    OMB Desk Officer: Ms. Shannah Koss.
    Written comments and recommendations on the proposed information 
collection should be sent to Ms. Koss at the Office of Management and 
Budget, Desk Officer for DoD, Room 10235, New Executive Office 
Building, Washington, DC 20503.
    DOD Clearance Officer: Mr. William Pearce.
    Written requests for copies of the information collection proposal 
should be sent to Mr. Pearce, WHS/DIOR, 1215 Jefferson Davis Highway, 
Suite 1204, Arlington, VA 22202-4302.

    Dated: July 7, 1995.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 95-17114 Filed 7-12-95; 8:45 am]
BILLING CODE 5000-04-P