[Federal Register Volume 64, Number 153 (Tuesday, August 10, 1999)]
[Notices]
[Page 43357]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-20479]


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DEPARTMENT OF DEFENSE

Office of the Secretary


Submission for OMB, Review; Comment Request

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, Associated Form, and OMB Number: CHAMPUS Claim Patient's 
Request for Medical Payment; DD Form 2642; OMB Number 0720-0006.
    Type of Request: Extension.
    Number of Respondent: 956,000.
    Responses Per Respondent: 1.
    Annual Responses: 956,000.
    Average Burden Per Response: 15 minutes.
    Annual Burden Hours: 239,000.
    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 is used by TRICARE to 
determine beneficiary eligibility, other health insurance liability, 
certification that the beneficiary received care, and reimbursement for 
the medical services received.
    Affected Public: Individuals or households.
    Frequency: On occasion.
    Respondents Obligation: Required to Obtain or Retain Benefits.
    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 (Health Affairs), 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: August 4, 1999.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 99-20479 Filed 8-9-99; 8:45 am]
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