[Federal Register Volume 62, Number 97 (Tuesday, May 20, 1997)]
[Notices]
[Page 27590]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-13107]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary


Submission for OMB Review; Comment Request

ACTION: Notice.

-----------------------------------------------------------------------

    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 and Associated Forms: Third Party Collection Program 
(Insurance Information) DD Form 2569, OMB Number 0704-0323.
    Type of Request: Reinstatement With Change.
    Number of Respondents: 74,224.
    Responses per Respondent: 1.
    Annual Responses: 74,224.
    Average Burden per Response: 2.5 minutes.
    Annual Burden Hours: 3,043.
    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 retired 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: Individuals or Households.
    Frequency: On Occasion; Annually.
    Respondent's Obligation: Voluntary.
    OMB Desk Officer: Ms. Allison Eydt.
    Written comments and recommendations on the proposed information 
collection should be sent to Ms. Eydt at the Office of Management and 
Budget, Desk Officer for DoD/CHAMPUS, Room 10235, New Executive Office 
Building, Washington, DC 20503.
    DOD Clearance Officer: Mr. Robert Cushing.
    Written requests for copies of the information collection proposal 
should be sent to Mr. Cushing, WHS/DIOR, 1215 Jefferson Davis Highway, 
Suite 1204, Arlington, VA 22202-4302.

    Dated: May 14, 1997.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 97-13107 Filed 5-19-97; 8:45 am]
BILLING CODE 5000-04-M