[Federal Register Volume 64, Number 68 (Friday, April 9, 1999)]
[Notices]
[Page 17350]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-8799]


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DEPARTMENT OF DEFENSE

Office of the Secretary


Proposed Collection; Comment Request

AGENCY: Office of the Assistant Secretary of Defense for Health 
Affairs.

ACTION: Notice.

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    In accordance with section 3506(c)(2)(A) of the Paperwork Reduction 
Act of 1995, the Office of the Assistant Secretary of Defense for 
Health Affairs announces the proposed extension of a currently approved 
collection and seeks public comment on the provisions thereof. Comments 
are invited on: (a) Whether the proposed extension of 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 
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 
through the use of automated collection techniques or other forms of 
information technology.

DATES: Consideration will be given to all comments received June 8, 
1999.

ADDRESSES: Written comments and recommendations on the information 
collection should be sent to TRICARE Management Activity--Aurora, 
Office of Program Requirements, 16401 E. Centretech Parkway, ATTN: 
Graham Kolb, Aurora, CO 80011-9043.

FOR FURTHER INFORMATION CONTACT: To request more information on this 
proposed information collection, please write to the above address or 
call TRICARE Management Activity, Program Requirements Branch at (303) 
676-3580.
    Title, Associated Form, and OMB Number: CHAMPUS Claim Patient's 
Request for Medical Payment, DD Form 2642, OMB Number 0720-0006.
    Needs and Uses: This form is used solely by beneficiaries claiming 
reimbursement for medical expenses under the TRICARE Program [formerly 
the Civilian Health and Medical Program of the Uniformed Services 
(TRICARE/CHAMPUS)]. The information collected will be used by TRICARE/
CHAMPUS to determine beneficiary eligibility, other health insurance 
liability, certification that the beneficiary received the care, and 
reimbursement for the medical services received.
    Affected Public: Individual or households.
    Annual Burden Hours: 239,000.
    Number of Respondents: 956,000.
    Responses per Respondent: 1.
    Average Burden per Response: 15 minutes.
    Frequency: On occasion.

SUPPLEMENTARY INFORMATION:

Summary of Information Collection

    This collection instrument is for use by beneficiaries under the 
TRICARE Program [formerly the Civilian Health and Medical Program of 
the Uniformed Services (TRICARE/CHAMPUS)]. TRICARE/CHAMPUS is a health 
benefits entitlement program for the dependents of active duty Uniform 
Services members and deceased sponsors, retirees and their dependents, 
dependents of Department of Transportation (Coast Guard) sponsors, and 
certain North Atlantic Treaty Organizations, National Oceanic and 
Atmospheric Administration, and Public Health Service eligible 
beneficiaries. DD Form 2642 is used solely by TRICARE/CHAMPUS 
beneficiaries to file for reimbursement of costs paid to provider and 
suppliers for authorized health care services or supplies.

    Dated: April 5, 1999.
L.M. Bynum,
Alternate OSD, Federal Register Liaison Officer, Department of Defense.
[FR Doc. 99-8799 Filed 4-8-99; 8:45 am]
BILLING CODE 5001-10-M