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###### Department of Defense

###### Office of the Secretary

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

# AGENCY:

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

# ACTION:

60-Day 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                               ( print 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]

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