Proposed Collection; Comment Request, 29853 [2019-13468]

Download as PDF Federal Register / Vol. 84, No. 122 / Tuesday, June 25, 2019 / Notices Centretech Parkway Aurora, CO 80011– 9066, ATTN: Jahanbakhsh Badshah, or call 303–676–3881. SUPPLEMENTARY INFORMATION: Title; Associated Form; and OMB Number: Application for Champus Provider Status: Corporate Services Provider, DD Form 3030, 0720–0020. Needs and Uses: This information collection requirement is necessary to ensure that the conditions are met for authorization as a TRICARE/CHAMPUS Corporate Service Provider. Respondents are freestanding corporations and foundations seeking authorization under the TRICARE/ CHAMPUS program to provide otherwise covered professional services to eligible TRICARE/CHAMPUS beneficiaries. Affected Public: Business or other forprofit. Annual Burden Hours: 111.67. Number of Respondents: 335. Responses per Respondent: 1. Annual Responses: 335. Average Burden per Response: 20 minutes. Frequency: As required. Dated: June 20, 2019. Morgan E. Park, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 2019–13470 Filed 6–24–19; 8:45 am] BILLING CODE 5001–06–P DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DOD–2019–HA–0074] Proposed Collection; Comment Request Office of the Assistant Secretary of Defense for Health Affairs, DoD. ACTION: Information collection notice. AGENCY: In compliance with the Paperwork Reduction Act of 1995, the Defense Health Agency announces a proposed public information collection and seeks public comment on the provisions thereof. Comments are invited on: 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; the accuracy of the agency’s estimate of the burden of the proposed information collection; ways to enhance the quality, utility, and clarity of the information to be collected; and ways to minimize the burden of the information collection on khammond on DSKBBV9HB2PROD with NOTICES SUMMARY: VerDate Sep<11>2014 20:35 Jun 24, 2019 Jkt 247001 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 26, 2019. 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: Department of Defense, Office of the Chief Management Officer, Directorate for Oversight and Compliance, 4800 Mark Center Drive, Mailbox #24, Suite 08D09, Alexandria, VA 22350–1700. 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 Defense Health Agency Uniform Business Office, 8111 Gatehouse Road, Suite 200, Falls Church, VA 22042 Attn: DeLisa E. Prater, Program Manager, or call 703– 275–6380. SUPPLEMENTARY INFORMATION: Title; Associated Form; and OMB Number: Third Party Collection Program (Insurance Information); DD Form 2569; OMB Control Number 0720–0055. Needs and Uses: The information collection requirement is necessary to obtain health insurance policy information used for coordination of health care benefits and billing third party payers and other federal agencies for health care provided to their beneficiaries and also to civilian nonUniformed Service beneficiaries for health care provided to them. 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 (MTFs) 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. Also, for civilian non-Uniformed Services beneficiary and interagency patients, DD Form 2569 is necessary and serves as an PO 00000 Frm 00015 Fmt 4703 Sfmt 4703 29853 assignment of benefits approval to submit claims to payers on behalf of the patient and authorization to release medical information. Affected Public: Individuals or households. Annual Burden Hours: 394,000. Number of Respondents: 3,940,000. Responses per Respondent: 1.5. Annual Responses: 5,910,000. Average Burden per Response: 4 minutes. Frequency: On occasion. Dated: June 20, 2019. Morgan E. Park, Alternate OSD Federal Register, Liaison Officer, Department of Defense. [FR Doc. 2019–13468 Filed 6–24–19; 8:45 am] BILLING CODE 5001–06–P DEPARTMENT OF DEFENSE Department of the Navy [Docket ID: USN–2019–HQ–0013] Proposed Collection; Comment Request United States Naval Academy (USNA), DoD. ACTION: Information collection notice. AGENCY: In compliance with the Paperwork Reduction Act of 1995, the United States Naval Academy announces a proposed public information collection and seeks public comment on the provisions thereof. Comments are invited on: 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; the accuracy of the agency’s estimate of the burden of the proposed information collection; ways to enhance the quality, utility, and clarity of the information to be collected; and 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 26, 2019. 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: Department of Defense, Office of the Chief Management Officer, Directorate for Oversight and Compliance, 4800 Mark Center Drive, Mailbox #24, Suite 08D09, Alexandria, VA 22350–1700. SUMMARY: E:\FR\FM\25JNN1.SGM 25JNN1

Agencies

[Federal Register Volume 84, Number 122 (Tuesday, June 25, 2019)]
[Notices]
[Page 29853]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-13468]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID DOD-2019-HA-0074]


Proposed Collection; Comment Request

AGENCY: Office of the Assistant Secretary of Defense for Health 
Affairs, DoD.

ACTION: Information collection notice.

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SUMMARY: In compliance with the Paperwork Reduction Act of 1995, the 
Defense Health Agency announces a proposed public information 
collection and seeks public comment on the provisions thereof. Comments 
are invited on: 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; the 
accuracy of the agency's estimate of the burden of the proposed 
information collection; ways to enhance the quality, utility, and 
clarity of the information to be collected; and 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 
26, 2019.

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: Department of Defense, Office of the Chief Management 
Officer, Directorate for Oversight and Compliance, 4800 Mark Center 
Drive, Mailbox #24, Suite 08D09, Alexandria, VA 22350-1700.
    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 Defense Health 
Agency Uniform Business Office, 8111 Gatehouse Road, Suite 200, Falls 
Church, VA 22042 Attn: DeLisa E. Prater, Program Manager, or call 703-
275-6380.

SUPPLEMENTARY INFORMATION: 
    Title; Associated Form; and OMB Number: Third Party Collection 
Program (Insurance Information); DD Form 2569; OMB Control Number 0720-
0055.
    Needs and Uses: The information collection requirement is necessary 
to obtain health insurance policy information used for coordination of 
health care benefits and billing third party payers and other federal 
agencies for health care provided to their beneficiaries and also to 
civilian non-Uniformed Service beneficiaries for health care provided 
to them. 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 (MTFs) 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. Also, for civilian non-Uniformed 
Services beneficiary and interagency patients, DD Form 2569 is 
necessary and serves as an assignment of benefits approval to submit 
claims to payers on behalf of the patient and authorization to release 
medical information.
    Affected Public: Individuals or households.
    Annual Burden Hours: 394,000.
    Number of Respondents: 3,940,000.
    Responses per Respondent: 1.5.
    Annual Responses: 5,910,000.
    Average Burden per Response: 4 minutes.
    Frequency: On occasion.

    Dated: June 20, 2019.
Morgan E. Park,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 2019-13468 Filed 6-24-19; 8:45 am]
 BILLING CODE 5001-06-P
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