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###### Department of Defense

###### Office of the Secretary

          - [Docket ID DOD-2012-HA-0160]

# AGENCY:

Office of the Assistant Secretary of Defense for Health Affairs

# ACTION:

Notice.

# 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:
      -  Federal eRulemaking Portal: http://www.regulations.gov.                          Follow the instructions for submitting comments.                    
      -  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