[Federal Register Volume 81, Number 19 (Friday, January 29, 2016)]
[Notices]
[Page 5013]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-01702]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID DOD-2012-HA-0160]


Proposed Collection; Comment Request

AGENCY: Office of the Assistant Secretary of Defense for Health Affairs

ACTION: Notice.

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SUMMARY: In compliance with 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: (a) 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; (b) the accuracy of the 
agency's estimate of the burden of the proposed information collection; 
(c) ways to enhance the quality, utility, and clarity of the 
information to be collected; and (d) 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 March 
29, 2016.

ADDRESSES: You may submit comments, identified by docket number and 
title, by any of the following methods:
    <bullet> Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
    <bullet> Mail: Department of Defense, Office of the Deputy Chief 
Management Officer, Directorate of Oversight and Compliance, Regulatory 
and Audit Matters Office, 9010 Defense Pentagon, Washington, DC 20301-
9010.
    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 Defense Health 
Agency Uniform Business Office, Defense Health Headquarters, 7700 
Arlington Blvd., Falls Church, Virginia 22042, ATTN: DeLisa E. Prater, 
Program Manager, 703-681-3492. ext. 6757 (DSN 761).

SUPPLEMENTARY INFORMATION: 
    Title; Associated Form; and OMB Number: Third Party Collection 
Program/Medical Services Account/Other Health Insurance; DD Form 2569; 
OMB Control Number 0720-0055.
    Needs and Uses: The information collection requirement is necessary 
to obtain health insurance policy information used for coordination of 
health care benefits and billing third party payers and other federal 
agencies for health care provided to their beneficiaries and also to 
civilian non-Uniformed Service beneficiaries for health care provided 
to them. DoD implemented the Third Party Collection Program (TPCP) in 
FY87 based on the authority granted in 10 U.S.C. 1095 and implemented 
by 32 CFR 220 in accordance with the Consolidated Omnibus Budget 
Reconciliation Act of 1986 (COBRA) (Pub. L. 99-272, section 2001, April 
7, 1986). Under the TPCP, DoD is authorized to collect from third-party 
payers the cost of inpatient and outpatient services rendered to DoD 
beneficiaries who have other health insurance. Military treatment 
facilities (MTFs) are required to make this form available to third-
party payers upon request. A third-party payer may not request any 
other assignment of benefits form from the subscriber. Also, for 
civilian non-Uniformed Services 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 
authorization to release medical information.
    Affected Public: Individuals or households.
    Annual Burden Hours: 260,000.
    Number of Respondents: 3,900,000.
    Responses per Respondent: 1.
    Annual Responses: 3,900,000.
    Average Burden per Response: 4 minutes.
    Frequency: Annually, on occasion.
    The administration has placed an increased emphasis upon recovery 
of health care expenses under the TPCP, as authorized by 10 U.S.C. 1095 
and 1097b, and also from civilians and other federal agencies as 
authorized by 10 U.S.C. 1079b and 1085. Completion of this form, while 
increasing total burden hours, will aid in increasing revenue to 
improve services, operating efficiency and effectiveness within the 
Military Health System. Funds collected return directly to the 
operation and maintenance budget of the MTF where the care was 
delivered and are used to improve the quality of healthcare. Often the 
funds allow the continuation of programs or purchasing of equipment at 
the facilities for which there would otherwise not be funding. This 
information is collected either during the admission and/or discharge 
process for an inpatient stay or during the registration process for an 
outpatient visit or as soon as practical thereafter.

    Dated: January 26, 2016.
Morgan E. Park,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 2016-01702 Filed 1-28-16; 8:45 am]
 BILLING CODE 5001-06-P