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###### Department of Defense

###### Office of the Secretary

          - [Docket ID: DoD-2021-HA-0087]

# AGENCY:

The Office of the Assistant Secretary of Defense for Health Affairs, Department of Defense (DoD).

# ACTION:

Information collection notice.

# 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 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 October 25, 2021.

# 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:*                         DoD cannot receive written comments at this time due to the COVID-19 pandemic. Comments should be sent electronically to the docket listed above.                    

*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, ATTN: Zelly Zim, 8111 Gatehouse Road, 229D, Falls Church, VA 22042 or call 571-232-1551.

# 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.                

*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:*                     As required.                

Dated: August 17, 2021.

Aaron T. Siegel,

Alternate OSD Federal Register Liaison Officer, Department of Defense. 

[FR Doc. 2021-18133 Filed 8-23-21; 8:45 am]

BILLING CODE 5001-06-P