SUPPORTING STATEMENT FOR THE PAPERWORK REDUCTION ACT SUBMISSION
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 these forms 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 forms 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 forms will 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. These forms have 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 these forms are 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 November 29, 2012 (Vol. 77, No. 230, p. 71176). No comments were received.
9. Payment/Gift to respondents
None
10. Confidentiality
A Privacy Act Statement is provided on the forms. The specific uses for the information are provided on the forms; 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 2,924 hours is based on an annual projected use of 25,065 individuals.
The burden is based on an estimated (7 minutes) for the Enrollment Form and the Disenrollment form.
Enrollment Form Disenrollment Form
Response per respondent: 1 1
Number of respondents: 12,532.50 12,532.50
Hours per response: (7 minutes) (7 minutes)
Annual Hour Burden: 1,462 1,462
13. Cost to Respondents
$75,445.65
Used the average salary for the US which I believe is $53,320/year. (Online Reference: http://www.bls.gov/oes/current/oes_nat.htm)
53,320/yr = 1025.38/wk divided by 40 hrs. =25.63/per hour divided by 60 mins = .43/min X 7 =3.01 X number of respondents 25,065 = 75,445.65
Respondent have no upfront cost associated with this collection.
14. Cost to federal government
$216,561.60
There are no start-up cost because TRICARE plus is an established program. Additionally, there are no an annual maintenance fees.
The government contractors have indicated that the cost of processing one from is $8.64 times by the number of respondents/per year ( 25,065) = 216,561.60
15. Changes
Adjustment is due to reinstatement of a currently approved collection. Burden hours adjustments are due to the ever changing access to TRICARE Plus.
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 | EITSD |
| File Modified | 2013-09-23 |
| File Created | 2013-09-23 |