SUPPORTING STATEMENT - PART A
TRICARE Young Adult Application – 0720-0049
1. Need for the Information Collection
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 (Select 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. Section 702 allows qualified adult children not eligible for medical coverage at age 21 (23 if enrolled in a full-time course of study at an institution of higher learning approved by the Secretary of Defense) and are under age 26 to qualify to purchase medical coverage unless the dependent is enrolled in or eligible to purchase employer sponsored insurance per section 5000A(f)(2) of the Internal Revenue Code of 1986 or is married. The dependents shall be able to purchase either the TRICARE Prime or Select benefits depending meeting specific program requirements and the availability of a desired plan in their geographic location.
2. Use of the Information
Respondents are adult age dependents of active duty military and veteran service members. Respondents complete the DD-2947, “TRICARE Young Adult Application” in order to apply for, change, or terminate their TRICARE Young Adult coverage or to request a different Primary Care Manager (PCM). Respondents typically make these requests over the phone by calling their regional contractor responsible for processing the DD-2947. Respondents in the East and West of the U.S. process the DD-2947 through Humana and HealthNet respectively; respondents outside of those regions have their DD-2947 processed by International SOS.
Some respondents choose to obtain an electronic version of the appropriate DD-2947 via the Tricare.mil website. Respondents identify their geographical location via their residential zip code. The respondent is then presented with the application form that contains the contact information for the correct regional contractors responsible for processing the application. Eastern, Western and overseas respondents complete the DD-2947-1, DD-2947-2, and DD-2947-3 forms respectively. In a few cases, respondents residing in or near and overseas military treatment facility (MTF) will be provided the DD-2947 by MTF staff.
Respondents complete the form online or may download an electronic portable data format (.pdf) file to be completed, printed, signed, then submit a hardcopy by fax or mail.
Additionally, the DD-2947 may be accessed via the Beneficiary Web Enrollment (BWE) website at https://www.dmdc.osd.mil/appj/bwe/indexAction.do. The BWE is utilized for multiple information collections and is cleared under 0720-0008, a screenshot of the BWE Welcome page has been submitted as a part of the package for this ICR. Respondents complete and submit the form online or print, sign, and submit the completed form.
No other communications or invitations are sent to respondents. The successful collection of this information allows adult age dependents in enroll in TRICARE health coverage and in making the appropriate and necessary changes for continued coverage.
3. Use of Information Technology
About 21% of responses are collected electronically. The electronic submission rate is a bit lower because the former adult dependent child does not qualify to get a DoD Self-Service Logon until they are actually enrolled in TYA.
4. Non-duplication
The information obtained through this collection is unique and is not already available for use or adaptation from another cleared source.
5. Burden on Small Businesses
This information collection does not impose a significant economic impact on a substantial number of small businesses or entities.
6. Less Frequent Collection
This information is collected as required; collection of the information is necessary upon the initial application to purchase coverage, when a change in coverage is requested, upon request to terminate coverage, or to request change in PCM. Reducing the collection of information to occur less frequently would result in beneficiaries experiencing periods of not having coverage or maintaining coverage when they no longer desire to.
7. Paperwork Reduction Act Guidelines
This collection of information does not require collection to be conducted in a manner inconsistent with the guidelines delineated in 5 CFR 1320.5(d)(2).
8. Consultation and Public Comments
Part A: PUBLIC NOTICE
A 60-Day Federal Register Notice (FRN) for the collection published on Monday, July 30, 2018. The 60-Day FRN citation is 83 FRN 36562-36563; No comments were received during the 60-Day Comment Period.
A 30-Day Federal Register Notice for the collection published on Friday, September 28, 2018. The 30-Day FRN citation is 83 FRN 49075.
Part B: CONSULTATION
Within a working group internal to the Department of Defense, we have consulted with U.S. military service representatives and subject matter experts of the Defense Enrollment Eligibility Reporting System (DEERS) in order to ensure the design and processing of the DD-2947 are the most efficient.
9. Gifts or Payment
No payments or gifts are being offered to respondents as an incentive to participate in the collection.
10. Confidentiality
A Privacy Act Statement (PAS) is provided on each version of DD form 2947.
The applicable System of Record Notice (SORN) is DMDC 02, Defense Enrollment Eligibility Reporting System, located at:
https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/627618/dmdc-02-dod/
The Privacy Impact Assessment (PIA) the Defense Enrollment Eligibility Reporting System (DEERS) can be accessed using the following URL:
https://www.dmdc.osd.mil/appj/dwp/documents.jsp
Records Retention and Disposition Schedule:
Records will be maintained in accordance with the following approved disposition schedule:
• Subject: TRICARE Contractor Claims Records
• Description: These files consist of any record acquired or used by the fiscal intermediary and/or contractor in the development and processing of TRICARE CHAMPVA claims. These records include but are not limited to: claims (TRICARE claims or other forms approved by TRICARE) receipts (itemized statements); medical reports (operative or daily nursing notes, lab results, etc.) authorization
forms; non-availability statements; certifications of eligibility; double coverage
information; completed third party liability (guardianship); peer reviews and other
correspondence that support payments to beneficiaries, physicians, and other
suppliers of service under TRICARE.
• Cutoff: Close out at end of the calendar year in which received
• Disposition: Destroy 10 year(s) after cut off
• OSD RCS Series #: 911-01
• NARA Authority: DAA-0330-2014-0014-0001
11. Sensitive Questions
The form requests the applicant provide a personal identifier number, which may be either than the individual’s social security number (SSN) or the DoD Benefit Number (DBN). The DBN has yet to be widely used and known by beneficiaries for healthcare transactions. Additionally, the main data source to find the DBN is the Uniformed Services identification card (ID card). Since the applicants are former dependent children, they either never had access to their DBN on an ID card in the first place or no longer have access to their DBN when they turned in their ID card after aging out of military benefits. Requesting the SSN or DBN of respondents is necessary to determine coverage eligibility, tracking purposes and to confirm the respondent has been enrolled in coverage via DEERS. For these reasons, DHA has justified the continued use of the SSN until such time the DBN is readily known by beneficiaries through repeated use and through means of knowing the DBN from documents other than the ID card. An SSN Justification Memorandum has been submitted as part of this information collection package.
12. Respondent Burden and its Labor Costs
Part A: ESTIMATION OF RESPONDENT BURDEN
1a) DD-2947
Number of Respondents: 2,709
Number of Responses Per Respondent: 1
Number of Total Annual Responses: 2,709
Response Time: 15 minutes
Respondent Burden Hours: 677.25 hours
2) Total Submission Burden
Total Number of Respondents: 2,709
Total Number of Annual Responses: 1
Total Respondent Burden Hours: 677.25 hours
Part B: LABOR COST OF RESPONDENT BURDEN
1) DD-2947
Number of Total Annual Responses: 2,709
Response Time: 15 minutes
Respondent Hourly Wage: $ 7.25
Labor Burden per Response: $ 1.81
Total Labor Burden: $ 4,910.06
Overall Labor Burden
Total Number of Annual Responses: 2,709
Total Labor Burden: $ 4,910.06
The Respondent hourly wage was determined by using the [Department of Labor Wage Website] ([http://www.dol.gov/dol/topic/wages/index.htm]).
13. Respondent Costs Other Than Burden Hour Costs
About 210 respondents submit the DD-2947 to their regional contractor for processing by mail. Based on current U.S. postal rates, we estimate respondents will spend $98.70 annually on postage.
14. Cost to the Federal Government
Part A: LABOR COST TO THE FEDERAL GOVERNMENT
DD-2947-1
Number of Total Annual Responses: 2,709
Processing Time per Response: 15 minutes
Hourly Wage of Worker(s) Processing Responses : $ 23.06
Cost to Process Each Response: $ 5.765
Total Cost to Process Responses : $ 15,617.39
Overall Labor Burden to the Federal Government
Total Number of Annual Responses: 2,709
Total Labor Burden: $ 15,617.39
Part B: OPERATIONAL AND MAINTENANCE COSTS
Cost Categories
Equipme0nt: $0
Printing: $0
Postage: $0
Software Purchases: $0
Licensing Costs: $0
Other: $ 0
Total Operational and Maintenance Cost: $0.00
Part C: TOTAL COST TO THE FEDERAL GOVERNMENT
Total Labor Cost to the Federal Government: $ 15,617.39
Total Operational and Maintenance Costs: $0.00
Total Cost to the Federal Government: $ 15,617.39
15. Reasons for Change in Burden
The burden has decreased significantly since the previous approval due to the availability of more affordable civilian health care coverage options.
16. Publication of Results
The results of this information collection will not be published.
17. Non-Display of OMB Expiration Date
We are not seeking approval to omit the display of the expiration date of the OMB approval on the collection instrument.
18. Exceptions to “Certification for Paperwork Reduction Submissions”
We are not requesting any exemptions to the provisions stated in 5 CFR 1320.9.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Kaitlin Chiarelli |
| File Modified | 0000-00-00 |
| File Created | 2021-01-20 |