SUPPORTING STATEMENT FOR THE PAPERWORK REDUCTION ACT SUBMISSION
Public information collection requirements submitted for public comments and recommendations: TRICARE Plus enrollment / disenrollment forms.
A. JUSTIFICATION
1. Need and use
These collected instruments serve as an application for enrollment and disenrollment in the Department of Defense’s TRICARE Plus Health Plan established in accordance with Title 10 U.S.C. sections 1099 (which calls for a healthcare enrollment system) and 1086 (which authorizes TRICARE eligibility of Medicare Eligible persons and has resulted in the development of a new enrollment option called TRICARE Plus) and for the Assistant Secretary of Defense for Health Affairs Policy Memorandum to Established the TRICARE Plus Program, June 22, 2001.
2. Purpose and users of the information
These collected instruments serve as an application for enrollment and disenrollment in the Department of Defense’s TRICARE Plus Health Plan established in accordance with Title 10 U.S.C. sections 1099. The information hereby provides the TRICARE contractors with the necessary data to determine beneficiary eligibility and to identify the selection of a health care option.
3. Information collection techniques
The information collected on this form will be entered into the Composite Health Care System (CHCS) database, which must be updated on a regular basis to ensure that the information is current and accurate. The form itself will serve as documentation that the requirements of the law have been satisfied. Since the information requested is readily available to the respondent, we feel the completion of the form is not unduly burdensome.
4. Duplication and similar information
This information is not being collected by any other agency or component nor is it currently available in any other format. This form has simplified and standardized the process for collecting the required information. Duplication of information to be collected has been eliminated.
5. Small business
No small business or other small entities are involved in this collection of information.
6. Less frequent collections
Data cannot be collected on a less frequent basis. Currently this form is the only means of collecting enrollment or disenrollment information. It is crucial to collect the most up-to-date information on beneficiaries.
7. Special circumstances
There are no special circumstances for the collection of information for this program.
8. Federal Register Notice / Consultations
The Federal Register Notice for this collection of information was published on October 1, 2008 (73 FR 57061-57062). No comments were received.
9. Payment/Gift to respondents
None
10. Confidentiality
A Privacy Act Statement is provided on the form. The specific uses for the information are provided on the form; respondents are advised that disclosure is voluntary and made aware of the consequences of non-disclosure.
11. Sensitive Questions
Questions of a sensitive nature are not asked.
12. Burden Estimated (hour)
The total annual hour burden for the respondents of 2,933 hours is based on an annual projected use of 25,065 individuals. The burden is based on an estimated 0.117 hours (7 mins) for the Enrollment Form and the Disenrollment form.
Costs: Based on a GS 9 step 1 pay of $19.62.
19.62 x 0.117 =$2.30
$2.30 x 2,933 hours =$6,746
13. Cost to Respondents
None
14. Cost to federal government
The only cost to the government is the cost of the contractor involvement.
15. Changes
The change in burden is + 1,397 hours due to an increase in respondents.
This is a reinstatement of a previously approved collection.
16. Publication/Tabulation
There are no plans to publish or tabulate the information collected.
17. Expiration Date
Approval is not sought for avoiding display of the expiration date.
18. Exceptions to the Certification Statement
No exceptions to the certification statement are being sought
B. Collections of Information Employing Statistical Methods
Statistical methods are not employed for collection of this information.
| File Type | application/msword |
| File Title | SUPPORTING STATEMENT FOR THE PAPERWORK REDUCTION ACT SUBMISSION |
| Author | A Preferred User |
| Last Modified By | Patricia Toppings |
| File Modified | 2009-11-13 |
| File Created | 2009-10-15 |