[Federal Register Volume 78, Number 58 (Tuesday, March 26, 2013)]
[Pages 18324-18325]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-06852]



Office of the Secretary

[Docket ID: DoD-2012-HA-0160]

Submission for OMB Review; Comment Request

ACTION: Notice.


    The Department of Defense has submitted to OMB for clearance, the

[[Page 18325]]

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 April 
25, 2013.
    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).
    Type of Request: Extension.
    Number of Respondents: 2,936,905.
    Responses per Respondent: 1.
    Annual Responses: 2,936,905.
    Average Burden per Response: 3 minutes.
    Annual Burden Hours: 146,845.
    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. DoD implemented 
the Third Party Collection Program (TPCP) in FY87 based on the 
authority granted in 10 U.S.C. 1095 and implemented by 32 CFR part 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; individuals or 
    Frequency: Annually or on occasion (when insurance information 
    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, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, 
VA 22350-3100.

    Dated: March 12, 2013.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2013-06852 Filed 3-25-13; 8:45 am]