[Federal Register Volume 83, Number 123 (Tuesday, June 26, 2018)]
[Notices]
[Pages 29765-29766]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-13712]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID DOD-2018-HA-0038]


Proposed Collection; Comment Request

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

ACTION: Information collection notice.

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SUMMARY: In compliance with the Paperwork Reduction Act of 1995, the 
Defense Health Agency 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

[[Page 29766]]

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 August 
27, 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 Chief Management 
Officer, Directorate for Oversight and Compliance, 4800 Mark Center 
Drive, Mailbox #24 Suite 08D09, 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 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 Defense Health 
Agency, TRICARE Health Plan, Policy and Benefits, 8111 Gatehouse Road, 
Falls Church, VA, 22042, Ms. Vonda Lawson or call (703) 275-6221.

SUPPLEMENTARY INFORMATION: 
    Title; Associated Form; and OMB Number: TriCare DoD/CHAMPUS Medical 
Claim Patient's Request for Medical Payment; DD-2642; OMB Control 
Number 0720-0006.
    Needs and Uses: The DD-2642, ``TRICARE DoD/CHAMPUS Medical Claim 
Patient's Request for Medical Payment'' form is used by TRICARE 
beneficiaries to claim reimbursement for medical expenses under the 
TRICARE Program (formerly the Civilian Health and Medical Program of 
the Uniformed Services (CHAMPUS)). The information collected will be 
used by TRICARE to determine beneficiary eligibility, other health 
insurance liability, certification that the beneficiary has the 
received care, and reimbursement for medical services received.
    Affected Public: Individuals or Households.
    Annual Burden Hours: 207,500.
    Number of Respondents: 830,000.
    Responses per Respondent: 1.
    Annual Responses: 830,000.
    Average Burden per Response: 15 minutes.
    Frequency: On occasion.
    The respondents to this information collection are TRICARE 
beneficiaries which include active duty service members, retirees, 
family members, and others. The DD-2642 is used by beneficiaries to 
file for reimbursement of out-of-pocket costs paid to providers and 
suppliers for authorized health care services or supplies. The 
information collected by the DD-2642 also aids TRICARE in determining 
beneficiary eligibility, health insurance liability and to certify the 
beneficiary has received the medical care as indicated. Respondents may 
obtain the DD-2642 by various methods. The DD-2642 may be completed 
online via the TRICARE website, tricare.mil. Additionally, respondents 
may print the form from the TRICARE website or the Department of 
Defense forms web page, www.esd.whs.mil/Directives/forms/ and complete 
the DD-2642 by hand. Respondents may also call their designated 
regional contractor who can direct respondents on how to obtain the DD-
2642. Respondents can identify their regional contractor through the 
TRICARE website. Respondents residing overseas may visit their local 
military treatment facility Tricare Service Center to request a copy of 
the DD-2642. Respondents may complete the DD-2642 online and submit it 
immediately, or in some cases, choose to mail their completed DD-2642 
to their regional contractor. The regional contractor then enters the 
information into the TRICARE Record Encounter Data System.

    Dated: June 21, 2018.
Shelly E. Finke,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 2018-13712 Filed 6-25-18; 8:45 am]
 BILLING CODE 5001-06-P