[Federal Register Volume 86, Number 161 (Tuesday, August 24, 2021)]
[Notices]
[Page 47302]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-18133]


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

DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID: DoD-2021-HA-0087]


Proposed Collection; Comment Request

AGENCY: The Office of the Assistant Secretary of Defense for Health 
Affairs, Department of Defense (DoD).

ACTION: Information collection notice.

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

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 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 October 
25, 2021.

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: DoD cannot receive written comments at this time due to the 
COVID-19 pandemic. Comments should be sent electronically to the docket 
listed above.
    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, ATTN: Zelly Zim, 8111 Gatehouse Road, 229D, Falls Church, VA 
22042 or call 571-232-1551.

SUPPLEMENTARY INFORMATION:
    Title; Associated Form; and OMB Number: TriCare DoD/CHAMPUS Medical 
Claim Patient's Request for Medical Payment; DD Form 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: As required.

    Dated: August 17, 2021.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2021-18133 Filed 8-23-21; 8:45 am]
BILLING CODE 5001-06-P