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###### Department of Defense

###### Office of the Secretary

          - [Docket ID: DOD-2018-HA-0038]

# AGENCY:

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

# ACTION:

30-Day information collection notice.

# SUMMARY:

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.

# DATES:

Consideration will be given to all comments received by September 28, 2018.

# ADDRESSES:

                        Comments and recommendations on the proposed information collection should be emailed to Ms. Cortney Higgins, DoD Desk Officer, at                         *oira_submission@omb.eop.gov.*                         Please identify the proposed information collection by DoD Desk Officer, Docket ID number, and title of the information collection.                    

# FOR FURTHER INFORMATION CONTACT:

                        Fred Licari, 571-372-0493, or                         *whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil.*

# SUPPLEMENTARY INFORMATION:

*Title; Associated Form; and OMB Number:*                     TriCare DoD/CHAMPUS Medical Claim Patient's Request for Medical Payment; DD Form 2642; OMB Control Number 0720-0006.                

*Type of Request:*                     Extension.                

*Number of Respondents:*                     830,000.                

*Responses per Respondent:*                     1.                

*Annual Responses:*                     830,000.                

*Average Burden per Response:*                     15 minutes.                

*Annual Burden Hours:*                     207,500.                

*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.                

*Frequency:*                     As required.                

*Respondent's Obligation:*                     Voluntary.                

*OMB Desk Officer:*                     Ms. Cortney Higgins.                

You may also submit comments and recommendations, identified by Docket ID 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 ID 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:*                     Mr. Frederick Licari.                

                    Requests for copies of the information collection proposal should be sent to Mr. Licari at                     *whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil.*

Dated: August 24, 2018.

Aaron T. Siegel,

Alternate OSD Federal Register, Liaison Officer, Department of Defense.

[FR Doc. 2018-18747 Filed 8-28-18; 8:45 am]

 BILLING CODE 5001-06-P