[Federal Register Volume 74, Number 211 (Tuesday, November 3, 2009)]
[Notices]
[Pages 56822-56823]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-26407]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID DOD-2009-HA-0159]


Extension of a Currently Approved Collection

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

ACTION: Notice.

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SUMMARY: In compliance with Section 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 public 
information collection and seeks public comment on the provisions 
thereof. Comments are invited on: whether the proposed collection of 
information is necessary for the proper performance of the functions of 
the agency, including whether the information shall have practical 
utility; the accuracy of the agency's estimate of the burden of the 
proposed information collection; ways to enhance the quality, utility, 
and clarity of the information to be collected; and 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 January 
4, 2010.

ADDRESSES: You may submit comments, identified by docket 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 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 or to obtain a copy of the proposal and 
associated collection instruments, please write to the Office of the 
Assistant Secretary of Defense for Health Affairs (OASD), TRICARE 
Operations Division, Attn: Ms. Shane Pham, 5111 Leesburg Pike, Suite 
810(A), Falls Church, VA 22041-3206, or call TRICARE Operations 
Division, at 703-681-0039 ext. 8666.
    Title; Associated Form; and OMB Number: TRICARE Prime Enrollment 
Application/PCM Change Form DD Form 2876, and TRICARE Prime 
Disenrollment Application; DD Form 2877; OMB Number 0720-0008.
    Needs and Uses: This information is collected in accordance with 
the National Defense Authorization Act for Fiscal Year 1001 (Pub. L. 
106-398),

[[Page 56823]]

section 723(b)(E). These collection instruments serve as applications 
for the Enrollment, Primary Care Manager (PCM) Change and Disenrollment 
for the Department of Defense's TRICARE Prime program established in 
accordance with title 10 U.S.C. 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. 
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. The information 
collected on the TRICARE Prime Disenrollment Form provides the 
necessary data to disenroll a beneficiary from TRICARE Prime. The 
Disenrollment Application is needed to implement disenrollment from 
TRICARE Prime, TRICARE Prime Remote or the Uniformed Services Family 
Health Plan as requested by the enrollee. Failure to provide 
information will result in continued enrollment and beneficiaries' 
responsibility for payment of an enrollment fee.
    Affected Public: Individuals or Households.
    Annual Burden Hours: 22,317.
    Number of Respondents: 72,905.
    Responses per Respondent: 1.
    Average Burden per Response: TRICARE Prime Enrollment Application/
PCM Change Form: 20 minutes or .33% of an hour/TRICARE Prime 
Disenrollment--5 minutes or .083%. (average burden per response for 
completing both forms is 18.36 minutes or .30% of an hour).
    Frequency: On occasion.

SUPPLEMENTARY INFORMATION: 

Summary of Information Collection

    The Department of Defense established TRICARE Prime as a managed-
care option, similar to a civilian HMO (health maintenance 
organization). Active duty service members are required to be enrolled 
in TRICARE Prime or TRICARE Prime Remote. They must take action to 
enroll by filling out the appropriate enrollment form and submitting it 
to the Managed Care Support Contractor (MCSC). TRICARE Prime is also 
available to other TRICARE beneficiaries who are also required to fill 
out the appropriate enrollment or disenrollment forms. TRICARE Prime 
enrollee's health care is coordinated by a primary care manager (PCM) 
whom could be a part of a military treatment facility, a civilian 
network or TRICARE Prime Remote where eligible. In order to carry out 
this program, it is necessary that certain beneficiaries electing to 
enroll/disenroll in TRICARE Prime, TRICARE Prime Remote or change a PCM 
complete an enrollment application request. Completion of the 
enrollment forms is an essential element of the TRICARE Prime program.

    Dated: October 29, 2009.
Mitchell S. Bryman,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E9-26407 Filed 11-2-09; 8:45 am]
BILLING CODE 5001-06-P