[Federal Register Volume 59, Number 190 (Monday, October 3, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-24290]


[[Page Unknown]]

[Federal Register: October 3, 1994]


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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: Applicable Form, and OMB Control Number: Third Party 
Collection Program; DD Form 2569; OMB Control Number 0704-0323.
    Type of Request: Reinstatement.
    Number of Respondents: 1,224,311.
    Responses per Respondent: 1.
    Annual Responses: 1,224,311.
    Average Burden per Response: 2.5 minutes.
    Annual Burden Hours: 50,197.
    Needs and Uses: This information will be collected by military 
treatment facilities (MTF) admissions clerks from beneficiaries 
(dependents of retirees having (private health insurance) at the time 
of admission, or by clinic personnel from this same category of 
beneficiaries receiving outpatient care. It will assist the local MTF 
commander in determining the proper third party payers to bill for 
medical care provided to these beneficiaries, as well as facilitate the 
collection of reasonable hospital costs from third party payers.
    Affected Public: Individuals or households.
    Frequency: On occasion.
    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 P. 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: September 27, 1994.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 94-24290 Filed 9-30-94; 8:45 am]
BILLING CODE 5000-04-M