[Federal Register Volume 65, Number 111 (Thursday, June 8, 2000)]
[Notices]
[Pages 36417-36418]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-14417]


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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: Third Party Collection 
program (Record of Other Health Insurance; DD Form 2569; OMB Number 
0704-0323.
    Type of Request: Revision.
    Number of Respondents: 293,401.
    Responses Per Respondent: 1.
    Annual Responses: 293,401.
    Average Burden Per Response: 2.5 minutes.
    Annual Burden Hours: 12,030.
    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 decreased 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. 
Reimbursement will be used to enhance healthcare delivery in the 
Medical Treatment Facility (MTF). Information will also be used by the 
Military Health Services System and CHAMPUS Fiscal intermediaries to 
determine eligibility for care, deductibles, and copayments and by 
Health Affairs for program planning and management.

[[Page 36418]]

    Affected Public: Individuals or Households.
    Frequency: On occasion; annually.
    Respondent's 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, 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 24, 2000.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 00-14417 Filed 6-7-00; 8:45 am]
BILLING CODE 5001-10-M