[Federal Register Volume 86, Number 202 (Friday, October 22, 2021)]
[Notices]
[Pages 58645-58646]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-23110]


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DEPARTMENT OF DEFENSE

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


Submission for OMB Review; Comment Request

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

ACTION: 30-Day 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 November 
22, 2021.

ADDRESSES: Written comments and recommendations for the proposed 
information collection should be sent within 30 days of publication of 
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular 
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.

FOR FURTHER INFORMATION CONTACT: Angela Duncan, 571-372-7574, or 
[email protected].

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.
    Type of Request: Extension.
    Number of Respondents: 830,000.
    Responses per Respondent: 1.
    Annual Responses: 830,000.
    Average Burden per Response: 15 Minutes.

[[Page 58646]]

    Annual Burden Hours: 207,500.
    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.
    Frequency: As required.
    Respondent's Obligation: Voluntary.
    OMB Desk Officer: Ms. Julie Wise.
    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: Ms. Angela Duncan.
    Requests for copies of the information collection proposal should 
be sent to Ms. Duncan at [email protected].

    Dated: October 19, 2021.
Kayyonne T. Marston,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2021-23110 Filed 10-21-21; 8:45 am]
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