Submission for OMB Review; Comment Request, 62564-62565 [E9-28529]

Download as PDF 62564 Federal Register / Vol. 74, No. 228 / Monday, November 30, 2009 / Notices • Federal eRulemaking Portal: http:// 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 http:// 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: http:// 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 http:// 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: http:// 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 http:// 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: http:// 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 http:// 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 Frm 00014 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: http:// 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 http:// 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]


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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: http://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 http://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