Submission for OMB Review; Comment Request, 62564-62565 [E9-28529]
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62564
Federal Register / Vol. 74, No. 228 / Monday, November 30, 2009 / Notices
• Federal eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
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 https://
www.regulations.gov as they are
received without change, including any
personal identifiers or contact
information.
DoD Clearance Officer: Ms. Patricia
Toppings.
Written requests for copies of the
information collection proposal should
be sent to Ms. Toppings at WHS/ESD/
Information Management Division, 1777
North Kent Street, RPN, Suite 11000,
Arlington, VA 22209–2133.
Dated: November 19, 2009.
Patricia L. Toppings,
OSD Federal Register, Liaison Officer,
Department of Defense.
[FR Doc. E9–28523 Filed 11–27–09; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket No. DoD–2009–HA–0144]
Submission for OMB Review;
Comment Request
WReier-Aviles on DSKGBLS3C1PROD with NOTICES
ACTION:
Notice.
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 (44 U.S.C.
Chapter 35).
DATES: Consideration will be given to all
comments received by December 30,
2009.
Title and OMB Number: TRICARE
DoD/CHAMPUS Medical Claim
Patient’s Request for Medical Payment,
DD Form 2642, OMB Number 0720–
0006.
Type of Request: Reinstatement.
Number of Respondents: 3,000,000.
Responses per Respondent: 1.
Annual Responses: 3,000,000.
Average Burden per Response: 15
minutes.
Annual Burden Hours: 750,000 hours.
Needs and Uses: This form is used
solely by beneficiaries claiming
reimbursement for medical expenses
under the TRICARE Program. The
information collected will be used by
TRICARE/CHAMPUS to determine
VerDate Nov<24>2008
14:58 Nov 27, 2009
Jkt 220001
beneficiary eligibility, other health
insurance eligibility, certification of the
beneficiary eligibility and other health
insurance liability, certification that the
beneficiary received the care, and
reimbursement for the medical services
received.
Affected Public: Individuals or
households.
Frequency: On occasion.
Respondent’s Obligation: Required to
obtain or retain benefits.
OMB Desk Officer: Mr. John Kraemer.
Written comments and
recommendations on the proposed
information collection should be sent to
Mr. Kraemer at the Office of
Management and Budget, Desk Officer
for DoD, Room 10236, New Executive
Office Building, Washington, DC 20503.
You may also submit comments,
identified by docket number and title,
by the following method:
• Federal eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
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 https://
www.regulations.gov as they are
received without change, including any
personal identifiers or contact
information.
DoD Clearance Officer: Ms. Patricia
Toppings.
Written requests for copies of the
information collection proposal should
be sent to Ms. Toppings at WHS/ESD/
Information Management Division, 1777
North Kent Street, RPN, Suite 11000,
Arlington, VA 22209–2133.
Dated: November 13, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. E9–28524 Filed 11–27–09; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket No. DoD–2008–HA–0119]
Submission for OMB Review;
Comment Request
ACTION:
Notice.
The Department of Defense has
submitted to OMB for clearance the
following proposal for collection of
information under the provisions of the
PO 00000
Frm 00013
Fmt 4703
Sfmt 4703
Paperwork Reduction Act (44 U.S.C.
Chapter 35).
DATES: Consideration will be given to all
comments received by December 30,
2009.
Title and OMB Number: TRICARE
Plus Enrollment Application, DD Form
2853, and TRICARE Plus Disenrollment
Request, DD Form 2854; OMB Control
Number 0720–0028.
Type of Request: Reinstatement.
Number of Respondents: 25,065.
Responses per Respondent: 1.
Annual Responses: 25,065.
Average Burden per Response: 0.117
hours.
Annual Burden Hours: 2,933 hours.
Needs and Uses: These collected
instruments serve as an application for
enrollment and disenrollment in the
Department of Defense’s TRICARE Plus
Health Plan established in accordance
with Title 10 U.S.C. sections 1099
(which calls for a health care enrollment
system) and 1086 (which authorizes
TRICARE eligibility of Medicare Eligible
Persons and has resulted in the
development of a new enrollment
option called TRICARE Plus) and the
Assistant Secretary of Defense for
Health Affairs Policy Memorandum to
Establish the TRICARE Plus Program,
June 22, 2001. The information
collected hereby provides the TRICARE
contractors with necessary data to
determine beneficiary eligibility and to
identify the selection of a health care
option.
Affected Public: Individuals or
households.
Frequency: On occasion.
Respondent’s Obligation: Required to
obtain or retain benefits.
OMB Desk Officer: Mr. John Kraemer.
Written comments and
recommendations on the proposed
information collection should be sent to
Mr. Kraemer at the Office of
Management and Budget, Desk Officer
for DoD, Room 10236, New Executive
Office Building, Washington, DC 20503.
You may also submit comments,
identified by docket number and title,
by the following method:
• Federal eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
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 https://
www.regulations.gov as they are
received without change, including any
personal identifiers or contact
information.
E:\FR\FM\30NON1.SGM
30NON1
Federal Register / Vol. 74, No. 228 / Monday, November 30, 2009 / Notices
DoD Clearance Officer: Ms. Patricia
Toppings.
Written requests for copies of the
information collection proposal should
be sent to Ms. Toppings at WHS/ESD/
Information Management Division, 1777
North Kent Street, RPN, Suite 11000,
Arlington, VA 22209–2133.
Dated: November 13, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. E9–28529 Filed 11–27–09; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket No. DoD–2009–HA–0121]
Submission for OMB Review;
Comment Request
WReier-Aviles on DSKGBLS3C1PROD with NOTICES
ACTION:
Notice.
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 (44 U.S.C.
Chapter 35).
DATES: Consideration will be given to all
comments received by December 30,
2009.
Title and OMB Number: Department
of Defense Active Duty/Reserve Forces
Dental Examination; DD Form 2813;
OMB Number 0720–0022.
Type of Request: Reinstatement.
Number of Respondents: 885,000.
Responses per Respondent: 1.
Annual Responses: 885,000.
Average Burden per Response: 3
minutes.
Annual Burden Hours: 44,250 hours.
Needs and Uses: The information
collection requirement is necessary to
obtain and record the dental health
status of members of the Armed Forces.
This form is the means for civilian
dentists to record the results of their
findings and provide the information to
the member’s military organization. The
military organizations are required by
Department of Defense policy to track
the dental status of its members.
Affected Public: Business or other
profit; Not-for-profit institutions.
Frequency: Annually.
Respondent’s Obligation: Voluntary.
OMB Desk Officer: Mr. John Kraemer.
Written comments and
recommendations on the proposed
information collection should be sent to
Mr. Kraemer at the Office of
Management and Budget, Desk Officer
for DoD, Room 10236, New Executive
Office Building, Washington, DC 20503.
VerDate Nov<24>2008
14:58 Nov 27, 2009
Jkt 220001
You may also submit comments,
identified by docket number and title,
by the following method:
• Federal eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
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 https://
www.regulations.gov as they are
received without change, including any
personal identifiers or contact
information.
DoD Clearance Officer: Ms. Patricia
Toppings.
Written requests for copies of the
information collection proposal should
be sent to Ms. Toppings at WHS/ESD/
Information Management Division, 1777
North Kent Street, RPN, Suite 11000,
Arlington, VA 22209–2133.
Dated: November 13, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. E9–28526 Filed 11–27–09; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket No. DoD–2008–HA–0120]
Submission for OMB Review;
Comment Request
ACTION:
Notice.
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 (44 U.S.C.
Chapter 35).
DATES: Consideration will be given to all
comments received by December 30,
2009.
Title and OMB Number: DoD Patient
Safety Survey; OMB Control Number
0720–0034.
Type of Request: Reinstatement.
Number of Respondents: 14,022.
Responses per Respondent: 1.
Annual Responses: 14,022.
Average Burden Per Response: 10
minutes.
Annual Burden Hours: 2,384 hours.
Needs and Uses: In its ongoing
response to legislation, DoD
implemented a Web-based patient safety
culture survey to a census of all staff
working in Army, Navy, and Air Force
PO 00000
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Fmt 4703
Sfmt 4703
62565
Military Health System (MHS) facilities
in the U.S. and internationally,
including Military Treatment Facility
hospitals as well as ambulatory and
dental services. The survey obtains
MHS staff opinions on patient safety
issues such as teamwork,
communications, medical error
occurrence and response, error
reporting, and overall perceptions of
patient safety. The purpose of the
survey is to assess the current status of
patient safety in MHS facilities as well
as to provide baseline input for
assessment of patient safety
improvement over time. Survey results
will be prepared at the facility and
Service levels and MHS overall.
Affected Public: Individuals or
households; Federal Government.
Frequency: On occasion.
Respondent’s Obligation: Voluntary.
OMB Desk Officer: Mr. John Kraemer.
Written comments and
recommendations on the proposed
information collection should be sent to
Mr. Kraemer at the Office of
Management and Budget, Desk Officer
for DoD, Room 10236, New Executive
Office Building, Washington, DC 20503.
You may also submit comments,
identified by docket number and title,
by the following method:
• Federal eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
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 https://
www.regulations.gov as they are
received without change, including any
personal identifiers or contact
information.
DoD Clearance Officer: Ms. Patricia
Toppings.
Written requests for copies of the
information collection proposal should
be sent to Ms. Toppings at WHS/ESD/
Information Management Division, 1777
North Kent Street, RPN, Suite 11000,
Arlington, VA 22209–2133.
Dated: November 13, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer,
Department of Defense.
[FR Doc. E9–28525 Filed 11–27–09; 8:45 am]
BILLING CODE 5001–06–P
E:\FR\FM\30NON1.SGM
30NON1
]]>Agencies
[Federal Register Volume 74, Number 228 (Monday, November 30, 2009)]
[Notices]
[Pages 62564-62565]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-28529]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket No. DoD-2008-HA-0119]
Submission for OMB Review; Comment Request
ACTION: Notice.
-----------------------------------------------------------------------
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 (44 U.S.C. Chapter 35).
DATES: Consideration will be given to all comments received by December
30, 2009.
Title and OMB Number: TRICARE Plus Enrollment Application, DD Form
2853, and TRICARE Plus Disenrollment Request, DD Form 2854; OMB Control
Number 0720-0028.
Type of Request: Reinstatement.
Number of Respondents: 25,065.
Responses per Respondent: 1.
Annual Responses: 25,065.
Average Burden per Response: 0.117 hours.
Annual Burden Hours: 2,933 hours.
Needs and Uses: These collected instruments serve as an application
for enrollment and disenrollment in the Department of Defense's TRICARE
Plus Health Plan established in accordance with Title 10 U.S.C.
sections 1099 (which calls for a health care enrollment system) and
1086 (which authorizes TRICARE eligibility of Medicare Eligible Persons
and has resulted in the development of a new enrollment option called
TRICARE Plus) and the Assistant Secretary of Defense for Health Affairs
Policy Memorandum to Establish the TRICARE Plus Program, June 22, 2001.
The information collected hereby provides the TRICARE contractors with
necessary data to determine beneficiary eligibility and to identify the
selection of a health care option.
Affected Public: Individuals or households.
Frequency: On occasion.
Respondent's Obligation: Required to obtain or retain benefits.
OMB Desk Officer: Mr. John Kraemer.
Written comments and recommendations on the proposed information
collection should be sent to Mr. Kraemer at the Office of Management
and Budget, Desk Officer for DoD, Room 10236, New Executive Office
Building, Washington, DC 20503.
You may also submit comments, identified by docket number and
title, by the following method:
Federal eRulemaking Portal: https://www.regulations.gov.
Follow the instructions for submitting comments.
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 https://www.regulations.gov as they are received without
change, including any personal identifiers or contact information.
[[Page 62565]]
DoD Clearance Officer: Ms. Patricia Toppings.
Written requests for copies of the information collection proposal
should be sent to Ms. Toppings at WHS/ESD/Information Management
Division, 1777 North Kent Street, RPN, Suite 11000, Arlington, VA
22209-2133.
Dated: November 13, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E9-28529 Filed 11-27-09; 8:45 am]
BILLING CODE 5001-06-P
