Defense Acquisition Regulation System Seeks Public Comment on Info Collection: TRICARE Select Enrollment, Disenrollment, Change Form
A notice was published in the
SUPPLEMENTARY INFORMATION:
Title; Associated Form; and OMB Number: TRICARE Select Enrollment, Disenrollment, and Change Form; DD Form 3043; OMB Control Number 0720-0061.
Needs and Uses: The information collection requirement is necessary to obtain each non-active duty TRICARE beneficiary's personal information needed to: (1) Complete his/her enrollment into the TRICARE Select health plan option, (2) dis-enroll a beneficiary, or (3) change a beneficiary's enrollment information (e.g., address, add a dependent, report other health insurance). This information is required to ensure the beneficiary's TRICARE benefits and claims are administered based on their TRICARE plan of choice. Without this new enrollment form, each non-active duty TRICARE beneficiary is automatically defaulted into direct care, limiting their health care options to military hospitals and clinics. These beneficiaries would have no TRICARE coverage when using the TRICARE network of providers for services not available at their local military hospital or clinic.
Affected Public: Individuals or households.
Annual
Number of Respondents: 99,300.
Responses per Respondent: 1.
Annual Responses: 99,300.
Average Burden per Response: 15 minutes.
Frequency: On occasion.
Dated:
[FR Doc. 2021-13626 Filed 6-24-21;
* * *
Complete text: https://www.federalregister.gov/documents/2021/06/25/2021-13626/proposed-collection-comment-request
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