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, Applicable Form, and OMB Number: TRICARE Senior Prime

Enrollment Application Form: OMB No. 0720-[to be determined].

Type of Request: New collection; Emergency Processing requested

with a shortened public comment period ending May 4, 1998. An approval

date of May 15, 1998, is requested.

Number of Respondents: 77,381.

Responses per Respondent: 1.

Annual Responses: 77,381.

Average Burden Per Response: 20 minutes.

Annual Burden Hours: 25,536 hours.

Needs and Uses: This information collection is a requirement for

TRICARE Senior Prime, a joint demonstration project of military managed

health care conducted by the Department of Defense (DoD) and the

Department of Health and Human Services (HHS). Under this

demonstration, authorized by the Balanced Budget Act of 1997, DoD will

offer Medicare-eligible military retirees and their dependents

enrollment in a DoD-operated managed health care program. Medicare-

eligible beneficiaries will be offered the opportunity to enroll at

selected Medical treatment Facilities (MTFs) in a managed care program

modeled after the existing TRICARE Prime benefit. Medicare will

reimburse DoD on a capitated basis for health care services it provides

to the enrolled beneficiaries. Eligible beneficiaries seeking

enrollment in the program will be required to fill out an enrollment

application which will provide information pertaining to eligibility

for the program, personal information for identification purposes, and

information on other health insurance.

Affected Public: Individuals or households.

Frequency: On occasion.

Respondent's Obligation: Required to obtain or retain a benefit.

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, or via facsimile at (202) 395-

6974.

DOD Clearance Officer: Mr. Robert Cushing.

Requests for copies of the information collection proposal should

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

Suite 1204, Arlington, VA 22202-4302, or via facsimile at (703) 604-

6270, or requested telephonically at (703) 604-4582.

Dated: April 17, 1998.

Patricia L. Toppings,

Alternate OSD Federal Register, Liaison Officer, Department of Defense.

[FR Doc. 98-10746 Filed 4-22-98; 8:45 am]

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