Privacy Act of 1974; System of Records, 74176-74177 [2012-30030]
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74176
Federal Register / Vol. 77, No. 240 / Thursday, December 13, 2012 / Notices
collection of information is necessary
for the proper performance of the
functions of the agency, including
whether the information shall have
practical utility; (b) the accuracy of the
agency’s estimate of the burden of the
proposed information collection; (c)
ways to enhance the quality, utility, and
clarity of the information to be
collected; and (d) 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 February 11,
2013.
ADDRESSES: You may submit comments,
identified by docket number and title,
by any of the following methods:
• Federal eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
• Mail: Federal Docket Management
System Office, 4800 Mark Center Drive,
East Tower, Suite 02G09, Alexandria,
VA 22350–3100.
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.
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 Uniform Business
Office (UBO), OASD(HA)/TRICARE
Management Activity/Management
Control & Financial Studies, 7700
Arlington Boulevard, Suite 5101, Falls
Church, VA 22042, ATTN: DeLisa E.
Prater, Program Manager, 703–681–3492
ext. 6757 (DSN 761).
Title; Associated Form; and OMB
Number: Third Party Collection
Program/Medical Services Account/
Other Health Insurance; DD Form 2569;
OMB Control Number 0720–TBD
(previously OMB Control Number 0704–
0323).
Needs and Uses: The information
collection requirement is necessary to
obtain health insurance policy
information used for coordination of
health care benefits and billing thirdparty payers. DoD implemented the
Third Party Collection Program (TPCP)
in FY87 based on the authority granted
in 10 U.S.C. 1095 and implemented by
VerDate Mar<15>2010
16:21 Dec 12, 2012
Jkt 229001
32 CFR 220 in accordance with the
Consolidated Omnibus Budget
Reconciliation Act of 1986 (COBRA)
(Pub. L. 99–272, section 2001, April 7,
1986). Under the TPCP, DoD is
authorized to collect from third-party
payers the cost of inpatient and
outpatient services rendered to DoD
beneficiaries who have other health
insurance. Military treatment facilities
are required to make this form available
to third-party payers upon request. A
third-party payer may not request any
other assignment of benefits form from
the subscriber.
Affected Public: Business or other for
profit; Not-for-profit institutions.
Annual Burden Hours: 146,845.
Number of Respondents: 2,936,905.
Responses per Respondent: 1.
Average Burden per Response: 3
minutes.
Frequency: Annually, or on occasion
(when insurance information changes).
SUPPLEMENTARY INFORMATION:
Summary of Information Collection
The administration has placed an
increased emphasis upon recovery of
health care expenses under the TPCP, as
authorized by 10 U.S.C. 1095 and
1097b. Completion of this form, while
increasing total burden hours, will aid
in increasing revenue to improve
services, operating efficiency and
effectiveness within the Military Health
System. Funds collected return directly
to the operation and maintenance
budget of the MTF where the care was
delivered and are used to improve the
quality of healthcare. Often the funds
allow the continuation of programs or
purchasing of equipment at the facilities
for which there would otherwise not be
funding. This information is collected
either during the admission and/or
discharge process for an inpatient stay
or during the registration process for an
outpatient visit.
Dated: December 7, 2012.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2012–30032 Filed 12–12–12; 8:45 am]
BILLING CODE 5001–06–P
DEPARTMENT OF DEFENSE
Department of the Air Force
[Docket ID USAF–2012–0032]
Privacy Act of 1974; System of
Records
AGENCY:
Department of the Air Force,
DoD.
PO 00000
Frm 00013
Fmt 4703
Sfmt 4703
Notice to alter a System of
Records.
ACTION:
The Department of the Air
Force proposes to alter a system of
records notice in its existing inventory
of records systems subject to the Privacy
Act of 1974 (5 U.S.C. 552a), as amended.
DATES: This proposed action will be
effective on January 14, 2013 unless
comments are received which result in
a contrary determination. Comments
will be accepted on or before January
14, 2013.
ADDRESSES: You may submit comments,
identified by docket number and title,
by any of the following methods:
• Federal Rulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
• Mail: Federal Docket Management
System Office, 4800 Mark Center Drive
East Tower, 2nd Floor, Suite 02G09,
Alexandria, VA 22350–3100.
Instructions: All submissions received
must include the agency name and
docket number 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.
SUMMARY:
Mr.
Charles J. Shedrick, Department of the
Air Force Privacy Office, Air Force
Privacy Act Office, Office of Warfighting
Integration and Chief Information
Officer, ATTN: SAF/CIO A6, 1800 Air
Force Pentagon, Washington, DC 20330–
1800, or by phone at (202) 404–6575.
SUPPLEMENTARY INFORMATION: The
Department of the Air Force’s notices
for systems of records subject to the
Privacy Act of 1974 (5 U.S.C. 552a), as
amended, have been published in the
Federal Register and are available from
the address in FURTHER INFORMATION
CONTACT.
The proposed systems reports, as
required by 5 U.S.C. 552a(r) of the
Privacy Act, were submitted on
December 3, 2012 to the House
Committee on Oversight and
Government Reform, the Senate
Committee on Homeland Security and
Governmental Affairs, and the Office of
Management and Budget (OMB)
pursuant to paragraph 4c of Appendix I
to OMB Circular No. A–130, ‘‘Federal
Agency Responsibilities for Maintaining
Records About Individuals,’’ dated
February 8, 1996, (February 20, 1996, 61
FR 6427).
FOR FURTHER INFORMATION CONTACT:
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13DEN1
Federal Register / Vol. 77, No. 240 / Thursday, December 13, 2012 / Notices
Dated: December 7, 2012.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
locked rooms and cabinets. Those in
computer storage devices are protected
by computer system software.’’
RETENTION AND DISPOSAL:
F036 AF PC V
SYSTEM NAME:
Awards and Decorations (June 11,
1997, 62 FR 31793).
CHANGES:
*
*
*
*
*
SYSTEM IDENTIFIER:
Delete entry and replace with ‘‘F036
AFPC V’’.
*
*
*
*
*
SYSTEM LOCATION:
Delete entry and replace with
‘‘Headquarters, United States Air Force,
Washington DC 20330–1670. Directorate
of Personnel Program Actions,
Headquarters Air Force Personnel
Center, 550 C Street West, Randolph Air
Force Base, TX 78150–6001.
Headquarters of major commands and
at all levels down to and including Air
Force installations. Official mailing
addresses are published as an appendix
to the Air Force’s compilation of record
systems notices.’’
CATEGORIES OF INDIVIDUALS COVERED BY THE
SYSTEM:
SYSTEM MANAGER(S) AND ADDRESS:
Delete entry and replace with ‘‘Air
Force active duty, Air Force Reserve,
Air National Guard and United States
civilian personnel who are
recommended for an award.’’
Delete entry and replace with
‘‘Executive Director, Headquarters, Air
Force Personnel Center, 550 C Street
West, Randolph Air Force Base, TX
78150–6001.’’
CATEGORIES OF RECORDS IN THE SYSTEM:
Delete entry and replace with ‘‘Full
name, Social Security Number (SSN),
rank, office address, work and home
phone numbers, previous awards and/or
decorations.’’
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Delete entry and replace with ‘‘10
U.S.C. Chapter 857, Decorations and
Awards; as implemented by Air Force
Instruction 36–2803, The Air Force
Awards and Decorations Program; and
E.O. 9397 (SSN) as amended.’’
*
*
*
*
*
RETRIEVABILITY:
Delete entry and replace with ‘‘Name
and/or SSN.’’
srobinson on DSK4SPTVN1PROD with
SAFEGUARDS:
Delete entry and replace with
‘‘Records are accessed by person(s)
responsible for servicing the record
system with a Common Access Card
(CAC) in performance of their official
duties and by authorized personnel who
are properly screened and cleared for
need-to-know. Records are stored in
VerDate Mar<15>2010
16:21 Dec 12, 2012
Jkt 229001
Delete entry and replace with
‘‘Special Honors, trophies and awards
program sponsored by Air Force and
private organizations, including
nominations of individuals, units and
groups, announcements of awards and
related forms and correspondence at
Headquarters United States Air Force
(HQ USAF), Headquarters Air Force
Personnel Center (HQ AFPC), and Major
Command (MAJCOM) are destroyed
after 50 years. Decorations to
individuals (Military and Civilian)
disapproved by U.S. Military are
destroyed after 35 years. Approved/
disapproved decorations and awards at
initiating and intermediate monitoring
headquarters are destroyed after
decoration is awarded or 1 year after
disapproval. Decorations to foreign
nationals and U.S. citizens not
employed by U.S. government are
retired as permanent 2 years after
completion of case; records are stored at
Randolph AFB TX. Files are destroyed
by tearing into pieces, shredding,
pulping, macerating, or burning.
Computer records are destroyed by
erasing, deleting or overwriting.’’
NOTIFICATION PROCEDURES:
Delete entry and replace with
‘‘Individuals seeking to determine
whether information about themselves
is contained in this system should
address written inquiries to Directorate
of Personnel Program Actions,
Headquarters Air Force Personnel
Center, 550 C Street West, Randolph Air
Force Base, TX 78150–6001.
For verification purposes the
individual should provide their full
name, Social Security Number (SSN),
any details which may assist in locating
records, and their signature.
In addition, the requester must
provide a notarized statement or an
unsworn declaration made in
accordance with 28 U.S.C. 1746, in the
following format:
If executed outside the United States:
‘I declare (or certify, verify, or state)
under penalty of perjury under the laws
of the United States of America that the
foregoing is true and correct. Executed
on (date). (Signature)’.
If executed within the United States,
its territories, possessions, or
PO 00000
Frm 00014
Fmt 4703
Sfmt 4703
74177
commonwealths: ‘I declare (or certify,
verify, or state) under penalty of perjury
that the foregoing is true and correct.
Executed on (date). (Signature)’.’’
RECORD ACCESS PROCEDURES:
Delete entry and replace with
‘‘Individuals seeking to access records
about themselves contained in this
system should address written requests
to the Executive Director, Headquarters,
Air Force Personnel Center, 550 C Street
West, Randolph Air Force Base, TX
78150–6001 or to the agency officials at
location of assignment.
For verification purposes the
individual should provide their full
name, Social Security Number (SSN),
any details which may assist in locating
records and their signature.
In addition the requester must
provide a notarized statement or an
unsworn declaration made in
accordance with 28 U.S.C. 1746, in the
following format:
If executed outside the United States:
‘I declare (or certify, verify, or state)
under penalty of perjury under the laws
of the United States of America that the
foregoing is true and correct. Executed
on (date). (Signature)’.
If executed within the United States,
its territories, possessions, or
commonwealths: ‘I declare (or certify,
verify, or state) under penalty of perjury
that the foregoing is true and correct.
Executed on (date). (Signature)’.’’
CONTESTING RECORD PROCEDURES:
Delete entry and replace with ‘‘The
Air Force rules for accessing records,
and for contesting contents and
appealing initial agency determinations
are published in Air Force Instruction
33–332, Air Force Privacy Program or
may be obtained from the system
manager.’’
*
*
*
*
*
[FR Doc. 2012–30030 Filed 12–12–12; 8:45 am]
BILLING CODE 5001–05–P
DEPARTMENT OF DEFENSE
Defense Acquisition Regulations
System
[Docket No. DARS 2012–0044–0001]
Information Collection Requirement;
Defense Federal Acquisition
Regulation Supplement; Production
Surveillance and Reporting (OMB
Control Number 0704–0250)
Defense Acquisition
Regulations System, Department of
Defense (DoD).
ACTION: Notice; request for comments
regarding a proposed extension of an
AGENCY:
E:\FR\FM\13DEN1.SGM
13DEN1
Agencies
[Federal Register Volume 77, Number 240 (Thursday, December 13, 2012)]
[Notices]
[Pages 74176-74177]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-30030]
-----------------------------------------------------------------------
DEPARTMENT OF DEFENSE
Department of the Air Force
[Docket ID USAF-2012-0032]
Privacy Act of 1974; System of Records
AGENCY: Department of the Air Force, DoD.
ACTION: Notice to alter a System of Records.
-----------------------------------------------------------------------
SUMMARY: The Department of the Air Force proposes to alter a system of
records notice in its existing inventory of records systems subject to
the Privacy Act of 1974 (5 U.S.C. 552a), as amended.
DATES: This proposed action will be effective on January 14, 2013
unless comments are received which result in a contrary determination.
Comments will be accepted on or before January 14, 2013.
ADDRESSES: You may submit comments, identified by docket number and
title, by any of the following methods:
Federal Rulemaking Portal: https://www.regulations.gov.
Follow the instructions for submitting comments.
Mail: Federal Docket Management System Office, 4800 Mark
Center Drive East Tower, 2nd Floor, Suite 02G09, Alexandria, VA 22350-
3100.
Instructions: All submissions received must include the agency name
and docket number 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.
FOR FURTHER INFORMATION CONTACT: Mr. Charles J. Shedrick, Department of
the Air Force Privacy Office, Air Force Privacy Act Office, Office of
Warfighting Integration and Chief Information Officer, ATTN: SAF/CIO
A6, 1800 Air Force Pentagon, Washington, DC 20330-1800, or by phone at
(202) 404-6575.
SUPPLEMENTARY INFORMATION: The Department of the Air Force's notices
for systems of records subject to the Privacy Act of 1974 (5 U.S.C.
552a), as amended, have been published in the Federal Register and are
available from the address in FURTHER INFORMATION CONTACT.
The proposed systems reports, as required by 5 U.S.C. 552a(r) of
the Privacy Act, were submitted on December 3, 2012 to the House
Committee on Oversight and Government Reform, the Senate Committee on
Homeland Security and Governmental Affairs, and the Office of
Management and Budget (OMB) pursuant to paragraph 4c of Appendix I to
OMB Circular No. A-130, ``Federal Agency Responsibilities for
Maintaining Records About Individuals,'' dated February 8, 1996,
(February 20, 1996, 61 FR 6427).
[[Page 74177]]
Dated: December 7, 2012.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
F036 AF PC V
System Name:
Awards and Decorations (June 11, 1997, 62 FR 31793).
Changes:
* * * * *
System Identifier:
Delete entry and replace with ``F036 AFPC V''.
* * * * *
System Location:
Delete entry and replace with ``Headquarters, United States Air
Force, Washington DC 20330-1670. Directorate of Personnel Program
Actions, Headquarters Air Force Personnel Center, 550 C Street West,
Randolph Air Force Base, TX 78150-6001.
Headquarters of major commands and at all levels down to and
including Air Force installations. Official mailing addresses are
published as an appendix to the Air Force's compilation of record
systems notices.''
Categories of Individuals Covered by the System:
Delete entry and replace with ``Air Force active duty, Air Force
Reserve, Air National Guard and United States civilian personnel who
are recommended for an award.''
Categories of Records in the System:
Delete entry and replace with ``Full name, Social Security Number
(SSN), rank, office address, work and home phone numbers, previous
awards and/or decorations.''
Authority for Maintenance of the System:
Delete entry and replace with ``10 U.S.C. Chapter 857, Decorations
and Awards; as implemented by Air Force Instruction 36-2803, The Air
Force Awards and Decorations Program; and E.O. 9397 (SSN) as amended.''
* * * * *
Retrievability:
Delete entry and replace with ``Name and/or SSN.''
Safeguards:
Delete entry and replace with ``Records are accessed by person(s)
responsible for servicing the record system with a Common Access Card
(CAC) in performance of their official duties and by authorized
personnel who are properly screened and cleared for need-to-know.
Records are stored in locked rooms and cabinets. Those in computer
storage devices are protected by computer system software.''
Retention and disposal:
Delete entry and replace with ``Special Honors, trophies and awards
program sponsored by Air Force and private organizations, including
nominations of individuals, units and groups, announcements of awards
and related forms and correspondence at Headquarters United States Air
Force (HQ USAF), Headquarters Air Force Personnel Center (HQ AFPC), and
Major Command (MAJCOM) are destroyed after 50 years. Decorations to
individuals (Military and Civilian) disapproved by U.S. Military are
destroyed after 35 years. Approved/disapproved decorations and awards
at initiating and intermediate monitoring headquarters are destroyed
after decoration is awarded or 1 year after disapproval. Decorations to
foreign nationals and U.S. citizens not employed by U.S. government are
retired as permanent 2 years after completion of case; records are
stored at Randolph AFB TX. Files are destroyed by tearing into pieces,
shredding, pulping, macerating, or burning. Computer records are
destroyed by erasing, deleting or overwriting.''
System manager(s) and address:
Delete entry and replace with ``Executive Director, Headquarters,
Air Force Personnel Center, 550 C Street West, Randolph Air Force Base,
TX 78150-6001.''
Notification procedures:
Delete entry and replace with ``Individuals seeking to determine
whether information about themselves is contained in this system should
address written inquiries to Directorate of Personnel Program Actions,
Headquarters Air Force Personnel Center, 550 C Street West, Randolph
Air Force Base, TX 78150-6001.
For verification purposes the individual should provide their full
name, Social Security Number (SSN), any details which may assist in
locating records, and their signature.
In addition, the requester must provide a notarized statement or an
unsworn declaration made in accordance with 28 U.S.C. 1746, in the
following format:
If executed outside the United States: `I declare (or certify,
verify, or state) under penalty of perjury under the laws of the United
States of America that the foregoing is true and correct. Executed on
(date). (Signature)'.
If executed within the United States, its territories, possessions,
or commonwealths: `I declare (or certify, verify, or state) under
penalty of perjury that the foregoing is true and correct. Executed on
(date). (Signature)'.''
Record access procedures:
Delete entry and replace with ``Individuals seeking to access
records about themselves contained in this system should address
written requests to the Executive Director, Headquarters, Air Force
Personnel Center, 550 C Street West, Randolph Air Force Base, TX 78150-
6001 or to the agency officials at location of assignment.
For verification purposes the individual should provide their full
name, Social Security Number (SSN), any details which may assist in
locating records and their signature.
In addition the requester must provide a notarized statement or an
unsworn declaration made in accordance with 28 U.S.C. 1746, in the
following format:
If executed outside the United States: `I declare (or certify,
verify, or state) under penalty of perjury under the laws of the United
States of America that the foregoing is true and correct. Executed on
(date). (Signature)'.
If executed within the United States, its territories, possessions,
or commonwealths: `I declare (or certify, verify, or state) under
penalty of perjury that the foregoing is true and correct. Executed on
(date). (Signature)'.''
Contesting Record Procedures:
Delete entry and replace with ``The Air Force rules for accessing
records, and for contesting contents and appealing initial agency
determinations are published in Air Force Instruction 33-332, Air Force
Privacy Program or may be obtained from the system manager.''
* * * * *
[FR Doc. 2012-30030 Filed 12-12-12; 8:45 am]
BILLING CODE 5001-05-P