[Federal Register Volume 82, Number 240 (Friday, December 15, 2017)]
[Notices]
[Pages 59592-59593]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-27113]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID: DOD-2017-HA-0065]


Proposed Collection; Comment Request

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

ACTION: 60-Day information collection notice.

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SUMMARY: In compliance with the Paperwork Reduction Act of 1995, the 
Office of the Assistant Secretary of Defense for Health Affairs 
announces a proposed 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 February 
13, 2018.

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: Department of Defense, Office of the Deputy Chief 
Management Officer, Directorate for Oversight and Compliance, 
Regulatory and Advisory Committee Division, 4800 Mark Center Drive, 
Mailbox #24, Suite 08D09B, Alexandria, VA 22350-1700.
    Instructions: All submissions received must include the agency 
name, docket 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

[[Page 59593]]

received without change, including any personal identifiers or contact 
information.
    Any associated form(s) for this collection may be located within 
this same electronic docket and downloaded for review/testing. Follow 
the instructions at http://www.regulations.gov for submitting comments. 
Please submit comments on any given form identified by docket number, 
form number, and title.

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 contact Defense Health 
Agency, TRICARE Health Plan (J-10), ATTN: Mark Ellis, 7700 Arlington 
Boulevard, Falls Church, VA 22042, or call the TRICARE Health Plan, 
703-681-0039.

SUPPLEMENTARY INFORMATION: 
    Title; Associated Form; and OMB Number: TRICARE Select Enrollment, 
Disenrollment, and Change Form, DD Form 3043, OMB Control Number 0720-
XXXX.
    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 
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.
    Annual Burden Hours: 24,825.
    Number of Respondents: 99,300.
    Responses per Respondent: 1.
    Annual Responses: 99,300.
    Average Burden per Response: 15 minutes.
    Frequency: On occasion.
    Respondents could be any non-active duty TRICARE beneficiary who is 
not eligible for Medicare. These beneficiaries have the option of 
enrolling into either the TRICARE Prime or TRICARE Select plan option 
starting January 1, 2018. Those choosing to enroll in TRICARE Select 
can do so by submitting the DD Form 3043, using the BWE portal, or 
calling their Regional Contractor. If they choose to use the DD Form 
3043, they must complete the appropriate page(s) of the form and mail 
the form to their Regional Contractor. No other form is required to 
enroll, dis-enroll, or change an enrollment. Respondents can download 
the form from the DoD Forms Management Program website, or click on the 
link to the form on the TRICARE.mil website or their Regional 
Contractor's website, or obtain a copy from their local military 
hospital or clinic. The mailing address and toll-free customer service 
number for their Regional Contractor are included on the DD Form 3043. 
If using either website option, the respondent can type in the 
information on the form prior to printing it or handwrite the 
information after printing the blank form.

    Dated: December 12, 2017.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2017-27113 Filed 12-14-17; 8:45 am]
 BILLING CODE 5001-06-P