Billing Code: 6001-FR
DEPARTMENT OF DEFENSE
Office of the Secretary
[Docket ID: DoD-2024-HA-0036]
Submission for OMB Review; Comment Request
AGENCY: Office of the Assistant Secretary of Defense for Health Affairs (OASD(HA)),
Department of Defense (DoD).
ACTION: 30-day information collection notice.
SUMMARY: The DoD has submitted to the Office of Management and Budget (OMB) for
clearance the following proposal for collection of information under the provisions of the
Paperwork Reduction Act.
DATES: Consideration will be given to all comments received by [INSERT 30 DAYS FROM
DATE OF PUBLICATION IN THE FEDERAL REGISTER].
ADDRESSES: Written comments and recommendations for the proposed information collection
should be sent within 30 days of publication of this notice to
www.reginfo.gov/public/do/PRAMain. Find this particular information collection by selecting
"Currently under 30-day Review - Open for Public Comments" or by using the search function.
FOR FURTHER INFORMATION CONTACT: Reginald Lucas, (571) 372-7574, whs.mcalex.esd.mbx.dd-dod-information-collections@mail.mil.
SUPPLEMENTARY INFORMATION:
TITLE; ASSOCIATED FORM; AND OMB NUMBER: TRICARE Plus Enrollment and
Disenrollment Application Forms; DD Forms 2853 and 2854; OMB Control Number 0720-0028.
TYPE OF REQUEST: Revision.
NUMBER OF RESPONDENTS: 6,134.
RESPONSES PER RESPONDENT: 1.
ANNUAL RESPONSES: 6,134.

AVERAGE BURDEN PER RESPONSE: 7 minutes.
ANNUAL BURDEN HOURS: 716.
NEEDS AND USES: These collection instruments serve as an application for enrollment and
disenrollment in the DoD's TRICARE Plus Health Plan established in accordance with Title 10
U.S.C. 1099. The information collected provides the TRICARE contractors with the necessary
data to determine beneficiary eligibility and identify the selection of a health care option.
AFFECTED PUBLIC: Individuals or households.
FREQUENCY: On occasion.
RESPONDENT'S OBLIGATION: Required to Obtain or Retain Benefits.
OMB DESK OFFICER: Mr. Matt Eliseo.
You may also submit comments and recommendations, identified by Docket ID number and
title, by the following method:
•

Federal eRulemaking Portal: http://www.regulations.gov. Follow the instructions for

submitting comments.
Instructions: All submissions received must include the agency name, Docket ID 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.
DOD CLEARANCE OFFICER: Mr. Reginald Lucas.
Requests for copies of the information collection proposal should be sent to Mr. Lucas at
whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil.
Dated: June 20, 2024.

Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer,

Department of Defense.
[FR Doc. 2024-14016 Filed: 6/25/2024 8:45 am; Publication Date: 6/26/2024]