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[Federal Register Volume 79, Number 109 (Friday, June 6, 2014)]
[Notices]
[Pages 32719-32720]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-13171]

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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID: DoD-2014-HA-0088]

Proposed Collection; Comment Request

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

ACTION: Notice.

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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 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 
5, 2014.

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: 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 http://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 http://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 the TRICARE Dental 
Care Office, Health Plan Execution and Operation, Defense Health Agency 
(DHA), Rm 3M451, ATTN: COL Colleen C. Shull, Falls Church, VA 22042 or 
call (703) 681-9517, DSN 761.

SUPPLEMENTARY INFORMATION: 
    Title; Associated Form; and OMB Number: TRICARE Dental Program 
(TDP) Dentist's Claim Form CONUS and TRICARE Dental Program (TDP)

[[Page 32720]]

Dentist's Claim Form OCONUS; OMB Control Number 0720-0035.
    Needs and Uses: The TRICARE Dental Program (TDP) Claim Form(s). 
CONUS/OCONUS are required to gather information to make payment for 
legitimate dental claims and to assist in contractor surveillance and 
program integrity investigations and to audit financial transactions 
where the Department of Defense has a financial stake. The information 
from the claim form is also used to provide important cost-share 
explanations to the beneficiary.
    Affected Public: Business or other for profit.
    Annual Burden Hours: 1,006,415.
    Number of Respondents: 64,930.
    Responses per Respondent: 62.
    Annual Responses: 4,025,660.
    Average Burden per Response: 15 minutes.
    Frequency: On occasion.
    The Defense Health Agency (DHA) under the authority of the Office 
of the Assistant Secretary of Defense (Health Affairs)/Office of the 
Deputy Assistant Secretary of Defense has responsibility for management 
of the TRICARE Dental Program (TDP) as established in Title 10, United 
States Code, Section 1076a. The information collected to make payment 
for covered dental procedures provided by a licensed dentist to an 
eligible beneficiary can be sent to the TDP contractor electronically, 
fax or mail. Approximately 35% of all TDP network dental claims are 
filed electronically. Dental offices and patients can download the TDP 
claim form from the contractor's Web site.
    For non-network dentist, to include those in overseas locations, 
the use of the TDP Claim Form is highly encouraged. However, dental 
claims will be paid if all the required information is provided on a 
similar claim form.

    Dated: June 3, 2014.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2014-13171 Filed 6-5-14; 8:45 am]
BILLING CODE 5001-06-P
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