82 FR 235 pgs. 57962-57963 - Submission for OMB Review; Comment Request
Type: NOTICEVolume: 82Number: 235Pages: 57962 - 57963
Pages: 57962, 57963Docket number: [Docket ID: DOD-2017-HA-0064]
FR document: [FR Doc. 2017-26513 Filed 12-7-17; 8:45 am]
Agency: Defense Department
Official PDF Version: PDF Version
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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.
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 Oira_submission@omb.eop.gov. 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, whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil.
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
[top] 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
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]
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