83 FR 29765 - Proposed Collection; Comment Request

DEPARTMENT OF DEFENSE
Office of the Secretary

Federal Register Volume 83, Issue 123 (June 26, 2018)

Page Range		29765-29766
FR Document		2018-13712

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.

Federal Register, Volume 83 Issue 123 (Tuesday, June 26, 2018)

[Federal Register Volume 83, Number 123 (Tuesday, June 26, 2018)]
[Notices]
[Pages 29765-29766]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-13712]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID DOD-2018-HA-0038]


Proposed Collection; Comment Request

AGENCY: Office of the Assistant Secretary of Defense for Health Agency, 
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

[[Page 29766]]

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 
27, 2018.

ADDRESSES: You may submit comments, identified by docket number and 
title, by any of the following methods:
    Federal eRulemaking Portal: http://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 http://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 Defense Health 
Agency, TRICARE Health Plan, Policy and Benefits, 8111 Gatehouse Road, 
Falls Church, VA, 22042, Ms. Vonda Lawson or call (703) 275-6221.

SUPPLEMENTARY INFORMATION: 
    Title; Associated Form; and OMB Number: TriCare DoD/CHAMPUS Medical 
Claim Patient's Request for Medical Payment; DD-2642; OMB Control 
Number 0720-0006.
    Needs and Uses: The DD-2642, ``TRICARE DoD/CHAMPUS Medical Claim 
Patient's Request for Medical Payment'' form is used by TRICARE 
beneficiaries to claim reimbursement for medical expenses under the 
TRICARE Program (formerly the Civilian Health and Medical Program of 
the Uniformed Services (CHAMPUS)). The information collected will be 
used by TRICARE to determine beneficiary eligibility, other health 
insurance liability, certification that the beneficiary has the 
received care, and reimbursement for medical services received.
    Affected Public: Individuals or Households.
    Annual Burden Hours: 207,500.
    Number of Respondents: 830,000.
    Responses per Respondent: 1.
    Annual Responses: 830,000.
    Average Burden per Response: 15 minutes.
    Frequency: On occasion.
    The respondents to this information collection are TRICARE 
beneficiaries which include active duty service members, retirees, 
family members, and others. The DD-2642 is used by beneficiaries to 
file for reimbursement of out-of-pocket costs paid to providers and 
suppliers for authorized health care services or supplies. The 
information collected by the DD-2642 also aids TRICARE in determining 
beneficiary eligibility, health insurance liability and to certify the 
beneficiary has received the medical care as indicated. Respondents may 
obtain the DD-2642 by various methods. The DD-2642 may be completed 
online via the TRICARE website, tricare.mil. Additionally, respondents 
may print the form from the TRICARE website or the Department of 
Defense forms web page, www.esd.whs.mil/Directives/forms/ and complete 
the DD-2642 by hand. Respondents may also call their designated 
regional contractor who can direct respondents on how to obtain the DD-
2642. Respondents can identify their regional contractor through the 
TRICARE website. Respondents residing overseas may visit their local 
military treatment facility Tricare Service Center to request a copy of 
the DD-2642. Respondents may complete the DD-2642 online and submit it 
immediately, or in some cases, choose to mail their completed DD-2642 
to their regional contractor. The regional contractor then enters the 
information into the TRICARE Record Encounter Data System.

    Dated: June 21, 2018.
Shelly E. Finke,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 2018-13712 Filed 6-25-18; 8:45 am]
 BILLING CODE 5001-06-P

Federal Register / Vol. 83, No. 123 / Tuesday, June 26, 2018 / Notices 29765

FOR FURTHER INFORMATION CONTACT: Ms. registration form with a White Paper, of Æ Team Experience and Abilities—
Jennifer Smith, Deputy Director for no greater than 1000 words, describing 20%
Laboratory Management ASA(ALT) the novel technology concept,
Phase III: AUSA Innovators’ Corner
Office of the Deputy Assistant Secretary innovative application concept, and
of the Army, Research and Technology, integration with the Army’s • Up to twenty-five (25) xTechSearch
(703) 697–0685. modernization priorities and outlining finalists will be featured at Innovators’
SUPPLEMENTARY INFORMATION: Eligibility: their knowledge, skills, capabilities, and Corner at the 2018 AUSA Annual
The entities allowed to participate in approach for this challenge. Contestants’ Meeting and Exposition, 8–10 October
this competition are small businesses as concept papers will be reviewed by a 2018 in Washington, DC.
defined in 13 CFR part 121. To qualify, panel of subject matter experts and • Finalists will provide a display and
the participating entity must fall within judges who will select semifinalists who a presentation on their submission in an
the size standard by North American will be awarded a prize of $1000 and be Army-sponsored exhibit space and
Industry Classification System code invited to the Phase II xTechSearch engage with Department of Defense
541713, 541714, and 541715. Technology Pitch Forums. (DoD) customers, industry partners, and
There may be only one submission • Concept White Papers will be academia.
per business. In addition, each entity: ranked based on the novelty of the • Up to twelve (12) Phase III prize
• Shall provide registration proposed technology to revolutionizing winners will be announced, four (4)
information in the xTechSearch Cover and modernizing the Army. Each white each day. Phase III prize winners will be
Letter registration form; paper must include the following: awarded prizes of $125,000 and 6
• Shall be incorporated in and Æ Proposed Army Modernization
months to demonstrate proof-of-concept
maintain a primary place of business in for their xTechSearch technology, to be
Priority alignment,
the United States; Æ Proposed concept and current demonstrated at an xTechSearch Finale
• Shall perform the work in the technology maturity, Demonstration.
United States.
• May not be a Federal entity or • Concept White Paper Scoring Phase IV: xTechSearch Finale
Federal employee acting within the Criteria: Demonstration—April 2019
scope of their employment. Æ Potential for Impact/ • Each Phase III winner will
Registered participants shall be Revolutionizing the Army—50% demonstrate proof-of-concept for their
required to agree to assume any and all Æ Scientific and Engineering technology solution to senior DoD,
risks and waive claims against the Viability—30% Government, and industry leadership.
Federal Government and its related Æ Team Experience and Abilities— The winner of the Finale Demonstration
entities, except in the case of willful 20% will be awarded a prize of $200,000.
misconduct, for any injury, death, Phase II: xTechSearch Technology Authority: 15 U.S.C. Section 3719; Pub. L.
damage, or loss of property, revenue, or Pitches 96–480, Section 24, as added Pub. L. 111–
profits, whether direct, indirect, or 358, title I, Section 105a, Jan. 4, 2011 Stat.
consequential, arising from their • Up to one hundred twenty five 3989
participation in a prize competition, (125) selected contestant semi-finalists
will be invited to complete an in-person Brenda S. Bowen,
whether the injury, death, damage, or
Technology pitch to a panel of Army Army Federal Register Liaison Officer.
loss arises through negligence or
otherwise. and Department of Defense subject [FR Doc. 2018–13669 Filed 6–25–18; 8:45 am]
Participants shall be required to matter experts and judges at one of five BILLING CODE 5001–03–P
obtain liability insurance or selected locations across the United
demonstrate financial responsibility, in States.
amounts determined by the Army, for • xTechSearch Technology Pitches DEPARTMENT OF DEFENSE
claims by— will be ranked based on the novelty of
Office of the Secretary
• Third parties for death, bodily the proposed technology to
injury, or property damage, or loss revolutionizing and modernizing the [Docket ID DOD–2018–HA–0038]
resulting from an activity carried out in Army. Finalists will be selected based
connection with participation in a prize on the propensity of the technology to Proposed Collection; Comment
competition, with the Federal revolutionize Army missions, solve an Request
Government named as an additional Army capability gap, and catalyze with AGENCY: Office of the Assistant
insured under the registered Army assets. Each technology pitch Secretary of Defense for Health Agency,
participant’s insurance policy and must include a proposal to demonstrate DoD.
registered participants agreeing to proof-of-concept for the technologies ACTION: Information collection notice.
indemnify the Federal Government within 6 months.
against third party claims for damages • Up to twenty-five (25) finalists SUMMARY: In compliance with the
arising from or related to prize selected by the judge panel will receive Paperwork Reduction Act of 1995, the
competition activities; and a prize of $5000 and be invited to Defense Health Agency announces a
• Federal Government for damage or display an exhibit and make a formal proposed public information collection
loss to Government property resulting public oral presentation of their and seeks public comment on the
from such an activity. proposal at the 2018 AUSA Annual provisions thereof. Comments are
Prizes will be offered under 15 U.S.C. Meeting Innovators’ Corner in invited on: Whether the proposed
sradovich on DSK3GMQ082PROD with NOTICES

Section 3719 (Prize competitions). Washington, DC. collection of information is necessary
• The total prize pool is $1.95M. • Scoring Criteria: for the proper performance of the
Evaluation Criteria and Process Æ Potential for Impact/ functions of the agency, including
Revolutionizing the Army—50% whether the information shall have
Phase I: Concept White Paper Contest Æ Scientific and Engineering practical utility; the accuracy of the
• All interested eligible contestants Viability; Proof-of-Concept agency’s estimate of the burden of the
will submit a xTechSearch Cover Letter Demonstration Plan—30% proposed information collection; ways

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29766 Federal Register / Vol. 83, No. 123 / Tuesday, June 26, 2018 / Notices

to enhance the quality, utility, and Responses per Respondent: 1. following proposal for collection of
clarity of the information to be Annual Responses: 830,000. information under the provisions of the
collected; and ways to minimize the Average Burden per Response: 15 Paperwork Reduction Act.
burden of the information collection on minutes. DATES: Consideration will be given to all
respondents, including through the use Frequency: On occasion. comments received by July 26, 2018.
of automated collection techniques or The respondents to this information
collection are TRICARE beneficiaries ADDRESSES: Comments and
other forms of information technology. recommendations on the proposed
which include active duty service
DATES: Consideration will be given to all information collection should be
members, retirees, family members, and
comments received by August 27, 2018. emailed to Ms. Jasmeet Seehra, DoD
others. The DD–2642 is used by
ADDRESSES: You may submit comments, beneficiaries to file for reimbursement Desk Officer, at oira_submission@
identified by docket number and title, of out-of-pocket costs paid to providers omb.eop.gov. Please identify the
by any of the following methods: and suppliers for authorized health care proposed information collection by DoD
Federal eRulemaking Portal: http:// services or supplies. The information Desk Officer, Docket ID number, and
www.regulations.gov. Follow the collected by the DD–2642 also aids title of the information collection.
instructions for submitting comments. TRICARE in determining beneficiary FOR FURTHER INFORMATION CONTACT: Fred
Mail: Department of Defense, Office of Licari, 571–372–0493, or whs.mc-
eligibility, health insurance liability and
the Chief Management Officer, alex.esd.mbx.dd-dod-information-
to certify the beneficiary has received
Directorate for Oversight and collections@mail.mil.
the medical care as indicated.
Compliance, 4800 Mark Center Drive,
Respondents may obtain the DD–2642 SUPPLEMENTARY INFORMATION:
Mailbox #24 Suite 08D09, Alexandria,
by various methods. The DD–2642 may Title; Associated Form; and OMB
VA 22350–1700.
be completed online via the TRICARE Number: Basic Criminal History and
Instructions: All submissions received
website, tricare.mil. Additionally, Statement of Admission (Department of
must include the agency name, docket
respondents may print the form from Defense Child Care Services Programs);
number and title for this Federal
the TRICARE website or the Department DD Form 2981; OMB Control Number
Register document. The general policy
of Defense forms web page, 0704–0516.
for comments and other submissions
www.esd.whs.mil/Directives/forms/ and Type of Request: Reinstatement, with
from members of the public is to make
complete the DD–2642 by hand. change.
these submissions available for public
Respondents may also call their Number of Respondents: 5,000.
viewing on the internet at http://
designated regional contractor who can Responses per Respondent: 1.
www.regulations.gov as they are
direct respondents on how to obtain the Annual Responses: 5,000.
received without change, including any Average Burden per Response: 15
DD–2642. Respondents can identify
personal identifiers or contact minutes.
their regional contractor through the
information. Annual Burden Hours: 1,250.
TRICARE website. Respondents residing
FOR FURTHER INFORMATION CONTACT: To overseas may visit their local military Needs and Uses: The information
request more information on this treatment facility Tricare Service Center collection requirement is necessary to
proposed information collection or to to request a copy of the DD–2642. obtain a self-reported record of criminal
obtain a copy of the proposal and Respondents may complete the DD– history from each individual who comes
associated collection instruments, 2642 online and submit it immediately, into regular, reoccurring contact with
please write to the Defense Health or in some cases, choose to mail their children under the age of 18 years.
Agency, TRICARE Health Plan, Policy completed DD–2642 to their regional Individuals are required to self-report
and Benefits, 8111 Gatehouse Road, contractor. The regional contractor then any arrests, charges or convictions that
Falls Church, VA, 22042, Ms. Vonda enters the information into the would keep the individual from
Lawson or call (703) 275–6221. TRICARE Record Encounter Data obtaining or maintaining a favorable
SUPPLEMENTARY INFORMATION: System. suitability or fitness determination.
Title; Associated Form; and OMB Programs impacted are referenced
Dated: June 21, 2018.
Number: TriCare DoD/CHAMPUS within the 42 U.S. Code § 13041 and
Shelly E. Finke,
Medical Claim Patient’s Request for include impacted individuals such as
Medical Payment; DD–2642; OMB Alternate OSD Federal Register, Liaison employees, DoD contractors, providers,
Officer, Department of Defense.
Control Number 0720–0006. adults residing in a family child care
Needs and Uses: The DD–2642, [FR Doc. 2018–13712 Filed 6–25–18; 8:45 am]
home, volunteers, and others with
‘‘TRICARE DoD/CHAMPUS Medical BILLING CODE 5001–06–P regular reoccurring contact with
Claim Patient’s Request for Medical children.
Payment’’ form is used by TRICARE Affected Public: Individuals or
beneficiaries to claim reimbursement for DEPARTMENT OF DEFENSE Households.
medical expenses under the TRICARE Office of the Secretary Frequency: On occasion.
Program (formerly the Civilian Health Respondent’s Obligation: Required to
and Medical Program of the Uniformed [Docket ID DoD–2018–OS–0017] obtain or retain benefits.
Services (CHAMPUS)). The information OMB Desk Officer: Ms. Jasmeet
collected will be used by TRICARE to Submission for OMB Review; Seehra.
determine beneficiary eligibility, other Comment Request You may also submit comments and
sradovich on DSK3GMQ082PROD with NOTICES

health insurance liability, certification AGENCY: Office of the Under Secretary of recommendations, identified by Docket
that the beneficiary has the received Defense for Personnel and Readiness, ID number and title, by the following
care, and reimbursement for medical DoD. method:
services received. ACTION: 30-Day information collection Federal eRulemaking Portal: http://
Affected Public: Individuals or notice. www.regulations.gov. Follow the
Households. instructions for submitting comments.
Annual Burden Hours: 207,500. SUMMARY: The Department of Defense Instructions: All submissions received
Number of Respondents: 830,000. has submitted to OMB for clearance the must include the agency name, Docket

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Document Created: 2018-06-26 00:51:54
Document Modified: 2018-06-26 00:51:54

Category		Regulatory Information
Collection		Federal Register
sudoc Class		AE 2.7: GS 4.107: AE 2.106:
Publisher		Office of the Federal Register, National Archives and Records Administration
Section		Notices
Action		Information collection notice.
Dates		Consideration will be given to all comments received by August 27, 2018.
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 Defense Health Agency, TRICARE Health Plan, Policy and Benefits, 8111 Gatehouse Road, Falls Church, VA, 22042, Ms. Vonda Lawson or call (703) 275-6221.
FR Citation		83 FR 29765

83 FR 29765 - Proposed Collection; Comment Request

DEPARTMENT OF DEFENSEOffice of the Secretary

Federal Register Volume 83, Issue 123 (June 26, 2018)

DEPARTMENT OF DEFENSE
Office of the Secretary