This statement serves to inform you of the purpose for
collecting personal information required by the TRICARE
Dental Program (TDP) and how it will be used.
AUTHORITY:
10 U.S.C. Chapter 55, Medical
and Dental Care; 32 C.F.R. 199.13, TRICARE Dental Program;
38 U.S.C. 1781, Medical 160 and 164, Health Insurance Portability
and Accountability Act (HIPAA) Privacy and Security Rules; and E.O.
9397 (SSN), as amended.
PURPOSE:
To provide for enrollment, processing
of claims, and customer service to individuals eligible for TRICARE Dental
Program benefits.
ROUTINE USES:
In addition to those disclosures generally
permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974,
the DoD "Blanket Routine uses" under 5 U.S.C. 552a(b)(3)
apply to this collection. Information from this system may be shared with
federal, state, local, or foreign government agencies, and with
private business entities, including individual providers of care, on matters
relating to eligibility, claims pricing and payment, fraud, program abuse,
utilization review, quality assurance, peer review, program integrity,
third-party liability, coordination of benefits, and civil or criminal
litigation.
DISCLOSURE:
Voluntary. If you choose not to provide
your information, no penalty may be imposed, but absence of the requested
information may result in administrative delays.
