[Federal Register Volume 87, Number 100 (Tuesday, May 24, 2022)]
[Notices]
[Pages 31541-31542]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-11028]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID: DoD-2022-HA-0058]


Proposed Collection; Comment Request

AGENCY: Office of the Assistant Secretary of Defense for Health Affairs 
(OASD(HA)), Department of Defense (DoD).

ACTION: 60-Day 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 to enhance the quality, utility, and 
clarity of the information to be collected; and ways to minimize the

[[Page 31542]]

burden of the information collection on respondents, including the use 
of automated collection techniques or other forms of information 
technology.

DATES: Consideration will be given to all comments received by July 25, 
2022.

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 Assistant to the 
Secretary of Defense for Privacy, Civil Liberties, and Transparency, 
Regulatory Directorate, 4800 Mark Center Drive, Attn: 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 Uniform Business Office, 8111 Gatehouse Road, Suite #221 Falls 
Church, VA 22042-5101, DeLisa Prater, or call 703-275-6380.

SUPPLEMENTARY INFORMATION: 
    Title; Associated Form; and OMB Number: Third Party Collection 
Program (Insurance Information); DD Form 2569; OMB Control Number 0720-
0055.
    Needs and Uses: The DoD is authorized to collect ``reasonable 
charges'' from third party payers for the cost of inpatient and 
outpatient services rendered at military treatment facilities (MTFs) to 
military retirees, all dependents, and other eligible beneficiaries who 
have private health insurance. The DoD may also collect the cost of 
trauma or other medical care provided from civilians (or their 
insurers), and/or the average cost of health care provided to 
beneficiaries at DoD MTFs from other federal agencies. For DoD to 
perform such collections, eligible beneficiaries may elect to provide 
DoD with other health insurance information. For civilian non-
beneficiary and interagency patients, DD Form 2569 is necessary and 
serves as an assignment of benefits, approval to submit claims to 
payers on behalf of the patient, and authorizes the release of medical 
information. This form is available to third-party payers upon request.
    The collection of personal information from individuals of the 
public for use in medical services is authorized by Title 10 U.S.C. 
1095, ``Health Care Services Incurred on Behalf of Covered 
Beneficiaries: Collection from Third-Party Payers'' Title 32 CFR 220, 
``Collection From Third Party Payers of Reasonable Charges for 
Healthcare Services,'' Title 10 U.S.C. 1079b(a), ``Procedures for 
Charging Fees for Care Provided to Civilians; Retention and Use of Fees 
Collected,'' and Title 10 U.S.C. 1085, ``Medical and Dental Care from 
Another Executive Department: Reimbursement.''
    Affected Public: Individuals or households.
    Annual Burden Hours: 386,500.
    Number of Respondents: 3,865,000.
    Responses per Respondent: 1.5.
    Annual Responses: 5,797,500.
    Average Burden per Response: 4 minutes.
    Frequency: On occasion.

    Dated: May 17, 2022.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2022-11028 Filed 5-23-22; 8:45 am]
BILLING CODE 5001-06-P