This PDF is the current document as it appeared on Public Inspection on 09/25/2013 at 08:45 am.
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).
Consideration will be given to all comments received by October 28, 2013.Start Further Info
FOR FURTHER INFORMATION CONTACT:
Fred Licari, 571-372-0493.End Further Info End Preamble Start Supplemental Information
Title, Associated Form and OMB Number: TRICARE Plus Enrollment Application (DD 2853) and TRICARE Plus Disenrollment Request (DD 2854); OMB Control Number 0720-0028.
Type of Request: Reinstatement with Change
Number of Respondents: 25,065
Responses per Respondent: 1
Annual Responses: 25,065
Average Burden per Response: 7 minutes
Annual Burden Hours: 2,924
Needs and Uses: These collected instruments serve as an application for enrollment and disenrollment in the Department of Defense's TRICARE Plus Health Plan established in accordance with Title 10 U.S.C. 1099 (which calls for a healthcare enrollment system) and 1086 (which authorizes TRICARE eligibility of Medicare Eligible Persons and has resulted in the development of a new enrollment option called TRICARE Plus) and the Assistant Secretary of Defense for Health Affairs Policy Memorandum to Establish the TRICARE Plus Program, June 22, 2001. The information collected hereby provides the TRICARE contractors with necessary data to determine beneficiary eligibility and to identify the selection of a health care option.
Affected Public: Individuals or household.
Frequency: On occasion.
Respondent's Obligation: Required to Obtain or Retain a Benefit.
OMB Desk Officer: Mr. John Kraemer.
Written comments and recommendations on the proposed information collection should be sent to Mr. John Kraemer at the Office of Management and Budget, Desk Officer for DoD, Room 10236, New Executive Office Building, Washington, DC 20503.
You may also submit comments, identified by docket number and title, by the following method:
- Federal eRulemaking Portal: http://www.regulations.gov. Follow the instructions for submitting comments.
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.
DOD Clearance Officer: Ms. Patricia Toppings. Written requests for copies of the information collection proposal should be sent to Ms. Toppings at WHS/ESD Information Management Division, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100.Start Signature
Dated: September 23, 2013.
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2013-23442 Filed 9-25-13; 8:45 am]
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