[Federal Register Volume 82, Number 235 (Friday, December 8, 2017)]
[Notices]
[Pages 57962-57963]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-26513]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID: DOD-2017-HA-0064]


Submission for OMB Review; Comment Request

AGENCY: Defense Health Agency, Department of Defense.

ACTION: 14-day emergency information collection notice.

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SUMMARY: 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.

DATES: Consideration will be given to all comments received by December 
22, 2017.

ADDRESSES: Comments and recommendations on the proposed information 
collection should be emailed to Ms. Cortney Higgins, DoD Desk Officer, 
at [email protected]. Please identify the proposed 
information collection by DoD Desk Officer and the Docket ID number and 
title of the information collection.

FOR FURTHER INFORMATION CONTACT: Fred Licari, 571-372-0493, [email protected].

SUPPLEMENTARY INFORMATION:
    Title, Associated Form and OMB Number: TRICARE Select Enrollment, 
Disenrollment, and Change Form, DD Form 3043, OMB Control Number 0720-
XXXX.
    Type of Request: Emergency
    Number of Respondents: 99,300
    Responses per Respondent: 1
    Annual Responses: 99,300
    Average Burden per Response: 15 minutes
    Annual Burden Hours: 24,825
    Needs and Uses: The information collection requirement is necessary 
to obtain each non-active duty TRICARE beneficiary's personal 
information needed to: (1) Complete his/her enrollment into the TRICARE 
Select health plan option, (2) dis-enroll a beneficiary, or (3) change 
a beneficiary's enrollment information (e.g., address, add a dependent, 
report other health insurance). This information is required to ensure 
the beneficiary's TRICARE benefits and claims are administered based on 
their TRICARE plan of choice. Without this new enrollment form, each

[[Page 57963]]

non-active duty TRICARE beneficiary is automatically defaulted into 
direct care, limiting their health care options to military hospitals 
and clinics. These beneficiaries would have no TRICARE coverage when 
using the TRICARE network of providers for services not available at 
their local military hospital or clinic.
    Affected Public: Individuals or Households.
    Frequency: On occasion
    Respondent's Obligation: Voluntary.
    OMB Desk Officer: Ms. Cortney Higgins.
    You may also submit comments and recommendations, identified by 
Docket ID number and title, by the following method:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
    Instructions: All submissions received must include the agency 
name, Docket ID number and title 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://www.regulations.gov as they are received without 
change, including any personal identifiers or contact information.
    DOD Clearance Officer: Mr. Frederick Licari.
    Written requests for copies of the information collection proposal 
should be sent to Mr. Licari at WHS/ESD Directives Division, 4800 Mark 
Center Drive, East Tower, Suite 03F09, Alexandria, VA 22350-3100.

    Dated: December 5, 2017.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2017-26513 Filed 12-7-17; 8:45 am]
BILLING CODE 5001-06-P