# Proposed Collection; Comment Request
**AGENCY:**
Office of the Assistant Secretary of Defense for Health Affairs, DoD.
**ACTION:**
Information collection notice.
**SUMMARY:**
In compliance with the *Paperwork Reduction Act of 1995,* the Office of the Assistant Secretary of Defense for Health Affairs 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 agency's 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 August 26, 2019.
**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:* Department of Defense, Office of the Chief Management Officer, Directorate for Oversight and Compliance, 4800 Mark Center Drive, Mailbox #24, Suite 08D09, Alexandria, VA 22350-1700.
*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.
**FOR FURTHER INFORMATION CONTACT:**
To request more information on this proposed information collection or to obtain a copy of the proposal and associated collection instruments, please write to Defense Health Agency, TRICARE Health Plan, 16401 East Centretech Parkway Aurora, CO 80011-9066, ATTN: Jahanbakhsh Badshah, or call 303-676-3881.
**SUPPLEMENTARY INFORMATION:**
*Title; Associated Form; and OMB Number:* Application for Champus Provider Status: Corporate Services Provider, DD Form 3030, 0720-0020.
*Needs and Uses:* This information collection requirement is necessary to ensure that the conditions are met for authorization as a TRICARE/CHAMPUS Corporate Service Provider. Respondents are freestanding corporations and foundations seeking authorization under the TRICARE/CHAMPUS program to provide otherwise covered professional services to eligible TRICARE/CHAMPUS beneficiaries.
*Affected Public:* Business or other for-profit.
*Annual Burden Hours:* 111.67.
*Number of Respondents:* 335.
*Responses per Respondent:* 1.
*Annual Responses:* 335.
*Average Burden per Response:* 20 minutes.
*Frequency:* As required.
Dated: June 20, 2019.
Morgan E. Park,
Alternate OSD Federal Register Liaison Officer, Department of Defense.