TRICARE Young Adult Application

ICR 201105-0720-001

OMB: 0720-0049

Federal Form Document

Forms and Documents
Document
Name
Status
Form
New
Supporting Statement A
2011-03-22
IC Document Collections
IC ID
Document
Title
Status
197033 New
ICR Details
0720-0049 201105-0720-001
Historical Active 201103-0720-001
DOD/DODOASHA
TRICARE Young Adult Application
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 05/02/2011
Retrieve Notice of Action (NOA) 05/02/2011
  Inventory as of this Action Requested Previously Approved
10/31/2011 6 Months From Approved
32,000 0 0
8,000 0 0
0 0 0

The Ike Skelton National Defense Authorization Act for Fiscal Year 2011 (FY11), Section 702, aligns TRICARE Program eligibility by providing a means to extend the age of eligibility of TRICARE dependents from age 21 or 23 up to age 26 to allow the purchase of extended dependent medical coverage across existing TRICARE program options (Standard, Extra, and Prime). This is consistent with the intent of the Patient Protection and Affordable Care Act, the implementing Health and Human Services regulations, and the limitations of Chapter 55 of Title 10. Information gathered through this collection will be used by the regional managed care support contractors to process the applications to start, change, or terminate TRICARE Young Adult coverage.

PL: Pub.L. 111 - 383 702 Name of Law: null
  
PL: Pub.L. 111 - 383 702 Name of Law: null

0720-AB48 Final or interim final rulemaking 76 FR 23479 04/27/2011

No

1
IC Title Form No. Form Name
TRICARE Young Adult Application ddx605 TRICARE YOUNG ADULT APPLICATION

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 32,000 0 32,000 0 0 0
Annual Time Burden (Hours) 8,000 0 8,000 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
New collection.

No
No
Yes
No
No
Uncollected
Patricia Toppings 703 696-5284 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/22/2011


© 2024 OMB.report | Privacy Policy