Proposed Collection; Comment Request, 32240 [2014-12949]
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32240
Federal Register / Vol. 79, No. 107 / Wednesday, June 4, 2014 / Notices
Office of the Secretary
[Docket ID DoD–2014–HA–0085]
Proposed Collection; Comment
Request
Office of the Assistant
Secretary of Defense for Health Affairs
(DHA), DoD.
ACTION: Notice.
AGENCY:
In compliance with Section
3506(c)(2)(A) of the Paperwork
Reduction Act of 1995, the Office of the
Assistant Secretary of Defense for
Health Affairs (DHA) announces a
proposed public information collection
and seeks public comment on the
provisions thereof. Comments are
invited on: (a) Whether the proposed
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 August 4, 2014.
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.
Any associated form(s) for this
collection may be located within this
same electronic docket and downloaded
for review/testing. Follow the
instructions at https://
www.regulations.gov for submitting
comments. Please submit comments on
any given form identified by docket
number, form number, and title.
tkelley on DSK3SPTVN1PROD with NOTICES
SUMMARY:
VerDate Mar<15>2010
16:05 Jun 03, 2014
Jkt 232001
To
request more information on this
proposed information collection or to
obtain a copy of the proposal and
associated collection instruments,
please write to Defense Health Agency,
Medical Benefits and Reimbursement
Branch (MB&RB), 16401 E. Centretech
Parkway, Aurora, CO 80011–9066, or
(303) 676–3565.
FOR FURTHER INFORMATION CONTACT:
DEPARTMENT OF DEFENSE
SUPPLEMENTARY INFORMATION:
Title; Associated Form; and OMB
Number: TRICARE DoD/CHAMPUS
Medical Claim—Patient’s Request for
Medical Reimbursement; DD Form
2642; OMB Control Number 0720–0006.
Needs and Uses: This form is used
solely by beneficiaries requesting
reimbursement for medical expenses
under the TRICARE Program. The
information collected will be used by
TRICARE/CHAMPUS to determine
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.
Annual Burden Hours: 750,000.
Number of Respondents: 3,000,000.
Responses per Respondent: 1.
Total Annual Responses: 3,000,000.
Average Burden per Response: 15
minutes.
Frequency: On occasion.
This collection instrument is for use
by beneficiaries under the TRICARE
Program. TRICARE/CHAMPUS is a
health benefits entitlement program for
the dependents of active duty
Uniformed Services members and
deceased sponsors, retirees and their
dependents, dependents of the
Department of Homeland Security
(Coast Guard) sponsors, and certain
North Atlantic Treaty Organizations,
National Oceanic and Atmospheric
Administration, and Public Health
Service eligible beneficiaries. DD Form
2642 is used sole by TRICARE/
CHAMPUS beneficiaries to file for
reimbursement of costs paid to
providers and suppliers for authorized
health care services or supplies.
Dated: May 30, 2014.
Aaron Siegel,
Alternate OSD Federal Register Liaison
Officer, Department of Defense.
[FR Doc. 2014–12949 Filed 6–3–14; 8:45 am]
BILLING CODE 5001–06–P
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DEPARTMENT OF DEFENSE
Department of the Air Force
[Docket ID: USAF–2013–0018]
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 July 7, 2014.
FOR FURTHER INFORMATION CONTACT: Fred
Licari, 571–372–0493.
SUPPLEMENTARY INFORMATION:
Title, Associated Form And OMB
Number: Air Force Safety Automated
System (AFSAS); OMB Control Number
0701–XXXX.
Type Of Request: New Collection
Number of Respondents: 200
Responses per Respondent: 1
Annual Responses: 200
Average Burden per Response: 1 hour
Annual Burden Hours: 200
Needs And Uses: Information
collected in the AFSAS includes
individuals determined to be a factor in
an Air Force (AF) or Department of
Defense (DoD) mishap. The system
meets DoD Instruction 6055.1 series
reporting requirements governing
aviation, space, weapons, and ground
safety. Data collection includes
personnel who are involved in a DoD
related mishap, or experience an injury,
illness or exposure while on a military
installation or other areas under military
control. It also includes personnel who
operate a motorcycle on or off duty and
personnel who operate a motorcycle on
or off a DoD installation when in a duty
status on official business. Data are used
for analysis of safety risk and for
prevention of mishaps.
Affected Public: Individuals or
Households
Frequency: On occasion.
Respondent’s Obligation: Voluntary.
OMB Desk Officer: Ms. Jasmeet
Seehra.
Written comments and
recommendations on the proposed
information collection should be sent to
Ms. Jasmeet Seehra 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.
SUMMARY:
E:\FR\FM\04JNN1.SGM
04JNN1
Agencies
[Federal Register Volume 79, Number 107 (Wednesday, June 4, 2014)]
[Notices]
[Page 32240]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-12949]
[[Page 32240]]
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DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket ID DoD-2014-HA-0085]
Proposed Collection; Comment Request
AGENCY: Office of the Assistant Secretary of Defense for Health Affairs
(DHA), DoD.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: In compliance with Section 3506(c)(2)(A) of the Paperwork
Reduction Act of 1995, the Office of the Assistant Secretary of Defense
for Health Affairs (DHA) announces a proposed public information
collection and seeks public comment on the provisions thereof. Comments
are invited on: (a) Whether the proposed 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 August
4, 2014.
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.
Any associated form(s) for this collection may be located within
this same electronic docket and downloaded for review/testing. Follow
the instructions at https://www.regulations.gov for submitting comments.
Please submit comments on any given form identified by docket number,
form number, and title.
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 Defense Health
Agency, Medical Benefits and Reimbursement Branch (MB&RB), 16401 E.
Centretech Parkway, Aurora, CO 80011-9066, or (303) 676-3565.
SUPPLEMENTARY INFORMATION:
Title; Associated Form; and OMB Number: TRICARE DoD/CHAMPUS Medical
Claim--Patient's Request for Medical Reimbursement; DD Form 2642; OMB
Control Number 0720-0006.
Needs and Uses: This form is used solely by beneficiaries
requesting reimbursement for medical expenses under the TRICARE
Program. The information collected will be used by TRICARE/CHAMPUS to
determine 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.
Annual Burden Hours: 750,000.
Number of Respondents: 3,000,000.
Responses per Respondent: 1.
Total Annual Responses: 3,000,000.
Average Burden per Response: 15 minutes.
Frequency: On occasion.
This collection instrument is for use by beneficiaries under the
TRICARE Program. TRICARE/CHAMPUS is a health benefits entitlement
program for the dependents of active duty Uniformed Services members
and deceased sponsors, retirees and their dependents, dependents of the
Department of Homeland Security (Coast Guard) sponsors, and certain
North Atlantic Treaty Organizations, National Oceanic and Atmospheric
Administration, and Public Health Service eligible beneficiaries. DD
Form 2642 is used sole by TRICARE/CHAMPUS beneficiaries to file for
reimbursement of costs paid to providers and suppliers for authorized
health care services or supplies.
Dated: May 30, 2014.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2014-12949 Filed 6-3-14; 8:45 am]
BILLING CODE 5001-06-P