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Federal Register / Vol. 86, No. 161 / Tuesday, August 24, 2021 / Notices
completion is less than 30 minutes, based on staff testing of the survey. The questionnaire will be submitted electronically as part of the existing AmeriCorps grant application and questions have been crafted for ease of reporting and efficient collection. The questionnaire will be complemented with an in-depth set of grant application instructions. Staff will also be available to provide individualized assistance, if needed.
Dated: August 16, 2021.
Sonali Nijhawan, Director, AmeriCorps State and National.
FR Doc. 202118200 Filed 82321; 8:45 am BILLING CODE 605028P

DEPARTMENT OF DEFENSE
Office of the Secretary Docket ID: DoD2021HA0087

Proposed Collection; Comment Request The Office of the Assistant Secretary of Defense for Health Affairs, Department of Defense DoD.
ACTION: Information collection notice.
AGENCY:

In compliance with the Paperwork Reduction Act of 1995, the Defense Health Agency announces a proposed public information collection and seeks public comment on the provisions thereof. Comments are invited on: Whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; the accuracy of the agencys estimate of the burden of the proposed information collection; ways to enhance the quality, utility, and clarity of the information to be collected; and ways to minimize the burden of the information collection on respondents, including through the use of automated collection techniques or other forms of information technology.
DATES: Consideration will be given to all comments received by October 25, 2021.
ADDRESSES: You may submit comments, identified by docket number and title, by any of the following methods:
Federal eRulemaking Portal: http
www.regulations.gov. Follow the instructions for submitting comments.
Mail: DoD cannot receive written comments at this time due to the COVID19 pandemic. Comments should be sent electronically to the docket listed above.
Instructions: All submissions received must include the agency name, docket
lotter on DSK11XQN23PROD with NOTICES1

SUMMARY:

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number and title for this Federal Register document. The general policy for comments and other submissions from members of the public is to make these submissions available for public viewing on the internet at http
www.regulations.gov as they are received without change, including any personal identifiers or contact information.
To request more information on this proposed information collection or to obtain a copy of the proposal and associated collection instruments, please write to The Defense Health Agency, ATTN: Zelly Zim, 8111
Gatehouse Road, 229D, Falls Church, VA 22042 or call 5712321551.
SUPPLEMENTARY INFORMATION:
Title; Associated Form; and OMB
Number: TriCare DoD/CHAMPUS
Medical Claim Patients Request for Medical Payment; DD Form 2642; OMB
Control Number 07200006.
Needs and Uses: The DD2642, TRICARE DoD/CHAMPUS Medical Claim Patients Request for Medical Payment form is used by TRICARE
beneficiaries to claim reimbursement for medical expenses under the TRICARE
Program formerly the Civilian Health and Medical Program of the Uniformed Services CHAMPUS. The information collected will be used by TRICARE to determine beneficiary eligibility, other health insurance liability, certification that the beneficiary has the received care, and reimbursement for medical services received.
Affected Public: Individuals or households.
Annual Burden Hours: 207,500.
Number of Respondents: 830,000.
Responses per Respondent: 1.
Annual Responses: 830,000.
Average Burden per Response: 15
minutes.
Frequency: As required.
FOR FURTHER INFORMATION CONTACT:

Dated: August 17, 2021.
Aaron T. Siegel, Alternate OSD Federal Register Liaison Officer, Department of Defense.
FR Doc. 202118133 Filed 82321; 8:45 am BILLING CODE 500106P

DEPARTMENT OF DEFENSE
Office of the Secretary Docket ID: DoD2021HA0086

Proposed Collection; Comment Request The Office of the Assistant Secretary of Defense for Health Affairs, Department of Defense DoD.

AGENCY:

PO 00000

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Fmt 4703

Sfmt 4703

ACTION:

Information collection notice.

In compliance with the Paperwork Reduction Act of 1995, the Defense Health Agency announces a proposed public information collection and seeks public comment on the provisions thereof. Comments are invited on: Whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; the accuracy of the agencys estimate of the burden of the proposed information collection; ways to enhance the quality, utility, and clarity of the information to be collected; and ways to minimize the burden of the information collection on respondents, including through the use of automated collection techniques or other forms of information technology.
DATES: Consideration will be given to all comments received by October 25, 2021.
ADDRESSES: You may submit comments, identified by docket number and title, by any of the following methods:
Federal eRulemaking Portal: http
www.regulations.gov. Follow the instructions for submitting comments.
Mail: DoD cannot receive written comments at this time due to the COVID19 pandemic. Comments should be sent electronically to the docket listed above.
Instructions: All submissions received must include the agency name, docket number and title for this Federal Register document. The general policy for comments and other submissions from members of the public is to make these submissions available for public viewing on the internet at http
www.regulations.gov as they are received without change, including any personal identifiers or contact information.
SUMMARY:

To request more information on this proposed information collection or to obtain a copy of the proposal and associated collection instruments, please write to the Defense Health Agency, ATTN: Dr. Kimberely Aiyelawo, 7700 Arlington Blvd., Suite 5101, Falls Church, VA 22042 or call 7036813636.
SUPPLEMENTARY INFORMATION:
Title; Associated Form; and OMB
Number: Department of Defense Patient Safety Culture Survey; OMB Control Number 07200034.
Needs and Uses: The 2001 National Defense Authorization Act contains specific sections addressing patient safety in military and veterans health care systems. This legislation states that FOR FURTHER INFORMATION CONTACT:

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