Submission for OMB Review; Comment Request
SUMMARY: The
DATES: Consideration will be given to all comments received by
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION:
Title, Associated Form and OMB Number: TRICARE DoD/CHAMPUS Medical Claim--Patient's Request for Medical Reimbursement; DD Form 2642; OMB Control Number 0720-0006.
Type of Request: Reinstatement.
Number of Respondents: 774,000.
Responses per Respondent: 1.
Annual Responses: 774,000.
Average Burden per Response: 15 minutes.
Annual Burden Hours: 193,500.
Needs and Uses: This form is used solely by beneficiaries requesting reimbursement for medical expenses under the TRICARE Program. The information collected will be used by
Affected Public: Individuals or Households.
Frequency: On occasion.
Respondent's Obligation: Voluntary.
OMB Desk Officer: Mr.
Written comments and recommendations on the proposed information collection should be sent to Mr.
You may also submit comments, identified by docket number and title, by the following method:
* Federal eRulemaking Portal: http://www.regulations.gov. Follow the instructions for submitting comments.
Instructions: All submissions received must include the agency name, docket number and title for this
DOD Clearance Officer: Mr.
Written requests for copies of the information collection proposal should be sent to
Dated:
Alternate OSD Federal Register Liaison Officer,
Notice.
Citation: "80 FR 4906"
Document Number: "Docket ID: DoD-2014-HA-0085"
Federal Register Page Number: "4906"
"Notices"
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