[Federal Register Volume 61, Number 145 (Friday, July 26, 1996)]
[Notices]
[Pages 39121-39122]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-18976]


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DEPARTMENT OF DEFENSE

Proposed Collection; Comment Request

AGENCY: Office of the Assistant Secretary of Defense (Health Affairs), 
DOD.

ACTION: Notice.

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    In compliance with Section 3506(c)(2)(A) of the Paperwork Reduction 
Act of 1995, the Office of the Assistant Secretary of Defense (Health 
Affairs) announces the proposed reinstatement of a public information 
collection and seeks public comments on the provisions thereof. Health 
Affairs invites comments on: (a) 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; (b) The accuracy of the agency's estimate of the burden of the 
proposed 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 the use of automated collection techniques or other forms of 
information technology.

DATES: Consideration will be given to all comments received by 
September 24, 1996.

ADDRESSES: Written comments and recommendations on the proposed 
information collection should be sent to: the Office of the Assistant 
Secretary of Defense (Health Affairs) Health Services Operations and 
Readiness, (ATTN: LCDR Patrick Kelly), Five Skyline Place,

[[Page 39122]]

Suite 810, 5111 Leesburg Pike, Falls Church, Va., 22041-3206.

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 above address or call the Office of the Assistant 
Secretary of Defense (Health Affairs), Health Services and Readiness 
Support at (703) 681-8910.
    Title, Associated Form and OMB Number: Third Party Collection 
Program; DD Form 2569; OMB Control Number 0704-0323.
    Needs and Uses: The information contained in the DD Form 2569 will 
be used to collect reimbursement from private insurers for medical care 
provided to family members of retirees and deceased Service members 
having health insurance. Such monetary benefits accruing to the 
Military Medical Treatment Facility (MTF) will be used to enhance 
healthcare delivery in the MTF. Information will also be used by MTF 
staff and CHAMPUS Fiscal Intermediaries to determine eligibility for 
care, deductibles, and copayments and by Health Affairs for program 
planning and management.
    Affected Public: Family members of retirees and deceased Service 
members having health insurance.
    Annual Burden Hours: 55,221 Hours.
    Number of Respondents: 1,262,194.
    Responses per Respondent: 1.05.
    Average Burden per Response: 2.5 Minutes.
    Frequency: Yearly or on occasion when insurance information 
changes.

SUPPLEMENTARY INFORMATION:

Summary of Information Collection

    The DD Form 2569 is used to collect third party insurance 
information from family members of retirees and deceased Service 
members having health insurance. This information is collected either 
during the inpatient stay admission and/or discharge process or during 
the visit when a patient presents for an outpatient procedure.

    Dated: July 22, 1996.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 96-18976 Filed 7-25-96; 8:45 am]
BILLING CODE 5000-04-M