[Federal Register Volume 68, Number 244 (Friday, December 19, 2003)]
[Notices]
[Pages 70780-70781]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-31279]


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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).

DATES: Consideration will be given to all comments received by January 
20, 2004.
    Title, Form, and OMB Number: TRICARE Prime Enrollment/Disenrollment 
Applications; OMB Number 0720-0008.
    Type of Request: Reinstatement.
    Number of Respondents: 20,689.
    Responses Per Respondent: 1.
    Annual Responses: 20,689.
    Average Burden Per Response: 7 minutes.
    Annual Burden Hours: 2,150.
    Needs and Uses: These collection instruments serve as applications 
for the enrollment, disenrollment, and Primary Care Manager (PCM) 
Change for the Department of Defense's TRICARE Prime program 
established in accordance with Title 10, U.S.C., Section 1099, which 
calls for a healthcare enrollment system. Monthly payment options for 
retiree enrollment fees for TRICARE Prime are established in accordance 
with Title 10 U.S.C., section 1097a(c). The information collected on 
the TRICARE Prime Enrollment Application/PCM Change Form provides the 
necessary data to determine beneficiary eligibility, to identify the 
selection of a health care option, and to change the designated PCM 
when the beneficiary is relocating or merely requests a local PCM 
change, in accordance with the National Defense Authorization Act for 
Fiscal Year 2001, Pub. L. 106-398, section 723(b)(E). The TRICARE Prime 
Disenrollment Application serves to disenroll an enrollee from TRICARE 
Prime on a voluntary basis.
    Affected Public: Individuals or households.
    Frequency: On occasion.
    Respondent's Obligation: Required to obtain or retain benefits.
    OMB Desk Officer: Ms. Jacqueline Zeiher--Written comments and 
recommendations on the proposed information collection should be sent 
to Ms. Zeiher at the Office of Management and Budget, Desk Officer for 
DoD, Room 10236, 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.


[[Page 70781]]


    Dated: November 26, 2003.
Patricia L. Toppings,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 03-31279 Filed 12-18-03; 8:45 am]
BILLING CODE 5001-06-M