[Federal Register Volume 68, Number 218 (Wednesday, November 12, 2003)]
[Notices]
[Pages 64086-64087]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-28248]


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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).

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DATES: Consideration will be given to all comments received by December 
12, 2003.
    Title, Form Number, and OMB Number: Third Party Collection Program 
(Insurance Information); DD Form 2569; OMB Number 0704-0323.
    Type of Request: Revision.
    Number of Respondents: 511,232.

[[Page 64087]]

    Responses Per Respondent: 1.
    Annual Responses: 511,232
    Average Burden Per Response: 2.5 minutes.
    Annual Burden Hours: 20,961.
    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 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 co-payments and by Health Affairs for program planning 
and management.
    Affected Public: Individuals or Households.
    Frequency: On Occasion and Annually.
    Respondent's Obligation: Voluntary.
    OMB Desk Officer: Mr. John Finley. Written comments and 
recommendations on the proposed information collection should be sent 
to Mr. Finley 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: Ms. Jacqueline Davis.
    Written requests for copies of the information collection proposal 
should be sent to Ms. Davis, WHS/DIOR, 1215 Jefferson Davis Highway, 
Suite 1204, Arlington, VA 22202-4302.

    Dated: October 29, 2003.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 03-28248 Filed 11-10-03; 8:45 am]
BILLING CODE 5001-06-M