[Federal Register Volume 62, Number 97 (Tuesday, May 20, 1997)] [Notices] [Page 27590] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 97-13107] ======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF DEFENSE Office of the Secretary 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). Title and Associated Forms: Third Party Collection Program (Insurance Information) DD Form 2569, OMB Number 0704-0323. Type of Request: Reinstatement With Change. Number of Respondents: 74,224. Responses per Respondent: 1. Annual Responses: 74,224. Average Burden per Response: 2.5 minutes. Annual Burden Hours: 3,043. Needs and Uses: The information contained in the DD Form 2569 will be used to collect reimbursement from private insurers for medical care provided to family members of retired and deceased Service members having health insurance. Such monetary benefits accruing to the Military Medical Treatment Facility (MTF) will be used to enhance healthcare delivery in the MTF. Information will also be used by MTF staff and CHAMPUS Fiscal Intermediaries to determine eligibility for care, deductibles, and copayments and by Health Affairs for program planning and management. Affected Public: Individuals or Households. Frequency: On Occasion; Annually. Respondent's Obligation: Voluntary. OMB Desk Officer: Ms. Allison Eydt. Written comments and recommendations on the proposed information collection should be sent to Ms. Eydt at the Office of Management and Budget, Desk Officer for DoD/CHAMPUS, Room 10235, New Executive Office Building, Washington, DC 20503. DOD Clearance Officer: Mr. Robert Cushing. Written requests for copies of the information collection proposal should be sent to Mr. Cushing, WHS/DIOR, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Dated: May 14, 1997. Patricia L. Toppings, Alternate OSD Federal Register Liaison Officer, Department of Defense. [FR Doc. 97-13107 Filed 5-19-97; 8:45 am] BILLING CODE 5000-04-M