SUPPORTING STATEMENT FOR PAPERWORK REDUCTION ACT SUBMISSION
TRICARE Retiree Dental Program Enrollment Application,
OMB No. 0720-0015
Justification.
Need and Use.
In section 703 of the National Defense Authorization Act for fiscal Year 1997, Congress amended title 10, United States Code, by adding section 1076c, which directed implementation of a dental insurance plan for retirees of the Uniformed Services, their dependents, and certain other beneficiaries. This dental plan was implemented as the TRICARE Retiree Dental Program (TRDP) under 32 CFR 199.22, which establishes enrollment in the program as voluntary and accomplished by submission of an application to the TRDP contractor. The enrollment application allows the Department to collect the information necessary to properly identify and enroll applicants for TRDP dental coverage in accordance with 32 CFR 199.22. In completing a TRDP enrollment application, applicants acknowledge that they understand the benefits offered under the program and the rules they must follow to continue their participation in the program. In addition, completion of the application authorizes the Congressionally- mandated premium deductions from retired pay if pay is available and sufficient to cover the premium amount.
Purpose and Users of the Information.
Participation in the TRDP is voluntary and is open to retired members of Uniformed Services retirees, their eligible family members, and the surviving family members of deceased active duty and retired members. These individuals must indicate their decision to enroll in the program by completing and submitting the enrollment application to the Contractor that administers the TRDP. The Contractor makes enrollment applications available to potential enrollees in paper form through direct mailing, field distributions, and downloading from the TRDP web site (www.trdp.org). In addition, application by toll-free telephone or electronically from the web site is available. The Contractor currently uses and will continue to use the information collected in the application process to identify enrollment applicants, to evaluate their eligibility for the TRDP, to obtain applicants’ acknowledgement of the program’s rules and policies, to obtain authorization for automated premium deductions from retired pay if available and sufficient, to initiate premium collection either through retired pay deduction or direct billing, to process TRDP claims and inquiries, and to notify enrollees of any matters pertaining to their TRDP enrollment. There have been no other uses nor are any other uses contemplated.
Information Collection Techniques.
There are currently no information technology techniques available as alternatives or to reduce the burden. This form is used to collect specific factual information unique to individual beneficiaries.
Duplication and Similar Information.
Information required to complete enrollment is not available from any source other than the applicant. There is no duplication.
Small Business.
No small business or other small entities are involved in this collection of information.
Less Frequent Collections.
This information is required only once, at the time of initial application. Enrollment in the TRDP cannot be accomplished without it.
Special Circumstances.
There are no special circumstances that require the collection to be conducted in a manner inconsistent with the guidelines in 5 CFR 1320.5(d)(2).
Federal Register Notice
The Federal Register Notice for the extension of this collection was published on April 10, 2007 (Vol. 72, No. 68, pp. 17878-17879). No comments were received. A copy of the notice is attached.
Payment/Gift to respondents.
No payment or gifts will be provided to respondents.
Confidentiality.
There is no specific statement of assurance of confidentiality. However, the form contains the necessary Privacy Act disclosures and statements.
SSN is needed for identification/tracking purposes. To date the Department has made no decisions on the use of another unique identifier.
Sensitive Questions.
There are no questions of a sensitive nature.
Burden Estimate (hours).
The number of annual burden hours for this collection is estimated to be 17,833 based on 71,332 respondents annually and 15 minutes per response. The annual burden hours are calculated as follows:
Respondents: 71,332
Response time: 0.25
Response frequency 1
Burden hours: 17,833*
*(71,332 respondents x 0.25 hour per response x 1 response = 17,833 hours)
Cost to Respondents.
The will be no cost burden to respondents other than for postage only if the contractor-provided, postage-paid envelope is not used. Application by telephone is via a toll-free line.
Cost to Federal Government.
The only cost to the government is contract cost. The contractor is responsible for the information collection. The administrative costs associated with the information collection are included in the premiums paid by enrollees. There is no government subsidy of the TRDP premiums.
Change in Burden
The change in burden reflects an increase in the number of respondents and the time to respond (15 minutes instead of 9 minutes).
Publication/Tabulation
The information collected will not be tabulated or published.
Expiration Date.
Approval is not sought for avoiding display of the expiration date.
Certification Statement.
There are no exceptions to the certification statement in Item 19, “Certification for Paperwork Reduction Act Submission,” of OMB Form 83-1.
Collections of Information Employing Statistical Methods.
This entire section is non-applicable because the information collection does not utilize any statistical methods.
| File Type | application/msword |
| File Title | SUPPORTING STATEMENT FOR PAPERWORK REDUCTION ACT SUBMISSION |
| Author | Linda J. Winter |
| Last Modified By | pltoppings |
| File Modified | 2007-08-31 |
| File Created | 2007-07-05 |