[Federal Register Volume 71, Number 29 (Monday, February 13, 2006)]
[Notices]
[Page 7543]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-1268]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary

[No. DoD-2006-HA-0015]


Proposed Collection; Comment Request

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

ACTION: Notice.

-----------------------------------------------------------------------

    In accordance with Seciton 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 by April 
14, 2006.

ADDRESSES: You may submit comments, identified by docket number and/or 
RIN number and title, by any of the following methods:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
     Mail: Federal Docket Management System Office, 1160 
Defense Pentagon, Washington, DC 20301-1160.
    Instructions: All submissions received must include the agency name 
and docket number or Regulatory Information Number (RIN) for this 
Federal Register document. The general policy for comments and other 
submissions from members of the public is to make these submissions 
available for public viewing on the Internet at http://regulations.gov 
as they are received without change, including any personal identifiers 
or contact information.

FOR FURTHER INFORMATION CONTACT: To request more information on this 
proposed information collection, please write to TRICARE Management 
Activity--Aurora, Program Requirements Division, 16401 E. Centretech 
Parkway, ATTN: John Leininger, Aurora, CO 80011-9066 or call TRICARE 
Management Activity, Program Requirements Division at (303) 676-3613.
    Title Associated Form, and OMB Number: CHAMPUS Claim Form--
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. 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: 600,000.
    Number of Respondents: 2,400,000.
    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. TRICARE/CHAMPUS is a health benefits entitlement 
program for the dependents of active duty Uniform Services members and 
decreased sponsors, retirees and their dependents, dependents of 
Department of Homeland Security (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: January 30, 2006.
Patricia L. Toppings,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 06-1268 Filed 2-10-06; 8:45 am]
BILLING CODE 5001-06-M