Submission for OMB Review; Comment Request

DEPARTMENT OF DEFENSE

Office of the Secretary

Submission for OMB Review; Comment Request

ACTION: Notice.

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The Department of Defense has submitted to OMB for clearance, the

following proposal for collection of information under the provisions

of the Paperwork Reduction Act (44 U.S.C. Chapter 35).

Title, Associated Form, and OMB Number: TRICARE Retiree Dental

Program enrollment Form; Contractor Designed Format (No DD Form

Number); OMB Number 0720-0015.

Type of request: Extension.

Number of Respondents: 286,570.

Responses per Respondent: 1.

Annual Responses: 286,570.

Average Burden per response: 15 minutes.

Annual Burden Hours: 71,640.

Needs and Uses: Conditional approval for the information collection

was granted under OMB approval number 0720-0015 pending development of

a contractor designed enrollment form which is being submitted for

approval. The form will be submitted to OMB concurrently with

publication of the final rule. The collection instrument serves as an

application form for military members entitled to retired pay and

eligible dependents to enroll in the TRICARE Retiree Dental Program.

The enrollment application will allow the Department to collect the

information necessary to properly identify the program's applicants and

to determine their eligibility for enrollment in the TRICARE Retiree

Dental Program. In completing and signing an enrollment form,

applicants will acknowledge that they understand the benefits offered

under the program and the rules they must follow to continue their

participation in the program. Further, applicants will acknowledge that

the premium will be withheld from retired pay when such pay is

available. Initial enrollment will be for a period of 24 months

followed by month to month enrollment as long as the enrollee chooses

to continue enrollment.

Affected Public: Individuals or households.

Frequency: On occasion.

Respondent's Obligation: Required to obtain or retain benefits.

OMB Desk Officer: Ms. Allison Eydt.

Written comments and recommendations on the proposed information

collection should be sent to Ms. Eydt at the Office of Management and

Budget, Desk Officer for DoD/Health Affairs, Room 10235, New Executive

Office Building, Washington, DC 20503.

DOD Clearance Officer: Mr. Robert Cushing.

Written requests for copies of the information collection proposal

should be sent to Mr. Cushing, WHS/DIOR, 1215 Jefferson Davis Highway,

Suit 1204, Arlington, VA 22202-4302.

Dated: December 15, 1997.

Patricia L. Toppings,

Alternate OSD Federal Register Liaison Officer, Department of Defense.

[FR Doc. 97-33112 Filed 12-18-97; 8:45 am]

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