Pia

PRIVACY IMPACT ASSESSMENT (PIA)
For the
Assistance Reporting Tool (ART)
TRICARE Management Activity (TMA)

SECTION 1: IS A PIA REQUIRED?
a. Will this Department of Defense (DoD) information system or electronic collection of
information (referred to as an "electronic collection" for the purpose of this form) collect,
maintain, use, and/or disseminate PII about members of the public, Federal personnel,
contractors or foreign nationals employed at U.S. military facilities internationally? Choose
one option from the choices below. (Choose (3) for foreign nationals).
(1) Yes, from members of the general public.
(2) Yes, from Federal personnel* and/or Federal contractors.
(3) Yes, from both members of the general public and Federal personnel and/or Federal contractors.
(4) No
* "Federal personnel" are referred to in the DoD IT Portfolio Repository (DITPR) as "Federal employees."

b. If "No," ensure that DITPR or the authoritative database that updates DITPR is annotated
for the reason(s) why a PIA is not required. If the DoD information system or electronic
collection is not in DITPR, ensure that the reason(s) are recorded in appropriate
documentation.
c. If "Yes," then a PIA is required. Proceed to Section 2.

DD FORM 2930 NOV 2008

Page 1 of 19

SECTION 2: PIA SUMMARY INFORMATION
a. Why is this PIA being created or updated? Choose one:
New DoD Information System

New Electronic Collection

Existing DoD Information System

Existing Electronic Collection

Significantly Modified DoD Information
System

b. Is this DoD information system registered in the DITPR or the DoD Secret Internet Protocol
Router Network (SIPRNET) IT Registry?
Yes, DITPR

Enter DITPR System Identification Number

Yes, SIPRNET

Enter SIPRNET Identification Number

13918

No

c. Does this DoD information system have an IT investment Unique Project Identifier (UPI), required
by section 53 of Office of Management and Budget (OMB) Circular A-11?
No

Yes
If "Yes," enter UPI

UII: 007-000001651

If unsure, consult the Component IT Budget Point of Contact to obtain the UPI.

d. Does this DoD information system or electronic collection require a Privacy Act System of
Records Notice (SORN)?
A Privacy Act SORN is required if the information system or electronic collection contains information about U.S. citizens
or lawful permanent U.S. residents that is retrieved by name or other unique identifier. PIA and Privacy Act SORN
information should be consistent.

No

Yes
If "Yes," enter Privacy Act SORN Identifier

DTMA 04

DoD Component-assigned designator, not the Federal Register number.
Consult the Component Privacy Office for additional information or
access DoD Privacy Act SORNs at: http://www.defenselink.mil/privacy/notices/

or
Date of submission for approval to Defense Privacy Office
Consult the Component Privacy Office for this date.

DD FORM 2930 NOV 2008

Page 2 of 19

e. Does this DoD information system or electronic collection have an OMB Control Number?
Contact the Component Information Management Control Officer or DoD Clearance Officer for this information.
This number indicates OMB approval to collect data from 10 or more members of the public in a 12-month period
regardless of form or format.

Yes
Enter OMB Control Number

DoD Clearance and OMB Licensing requirements are
currently being reviewed by the TMA Information
Collection Management Officer. The PIA will be updated
accordingly with their decision.

Enter Expiration Date
No
f. Authority to collect information. A Federal law, Executive Order of the President (EO), or DoD
requirement must authorize the collection and maintenance of a system of records.
(1) If this system has a Privacy Act SORN, the authorities in this PIA and the existing Privacy Act
SORN should be the same.
(2) Cite the authority for this DoD information system or electronic collection to collect, use, maintain
and/or disseminate PII. (If multiple authorities are cited, provide all that apply.)
(a) Whenever possible, cite the specific provisions of the statute and/or EO that authorizes
the operation of the system and the collection of PII.
(b) If a specific statute or EO does not exist, determine if an indirect statutory authority can
be cited. An indirect authority may be cited if the authority requires the operation or administration of
a program, the execution of which will require the collection and maintenance of a system of records.
(c) DoD Components can use their general statutory grants of authority (“internal
housekeeping”) as the primary authority. The requirement, directive, or instruction implementing the
statute within the DoD Component should be identified.
10 U.S.C. Chapter 55, Medical and Dental Care; 38 U.S.C. Chapter 17, Hospital, Nursing Home,
Domiciliary, and Medical Care; 32 CFR Part 199, Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS); DoDI 6015.23, Delivery of Healthcare at Military Treatment Facilities: Foreign
Service Care; Third-Party Collection; Beneficiary Counseling and Assistance Coordinators (BCACs); and
E.O. 9397 (SSN), as amended.

DD FORM 2930 NOV 2008

Page 3 of 19

g. Summary of DoD information system or electronic collection. Answers to these questions
should be consistent with security guidelines for release of information to the public.
(1) Describe the purpose of this DoD information system or electronic collection and briefly
describe the types of personal information about individuals collected in the system.
ART is a secure web-based system that captures feedback on and authorizations related to TRICARE
benefits. Customer service personnel use ART to document beneficiary questions and concerns related to
TRICARE and how those issues are resolved. The ART is also the primary means by which Military Medical
Support Office (MMSO) staff capture medical authorization determinations and claims assistance information
for remotely located service members, line of duty care, and care under the Transitional Care for Servicerelated Conditions benefit. ART allows users to track workload and resolution of TRICARE-related issues.
The data may also be used to create reports and statistical studies to determine historical and current trends
and future needs. Users are comprised of customer service personnel, to include Beneficiary Counseling and
Assistance Coordinators, Debt Collection Assistance Officers, personnel, family support, recruiting
command, case managers, and others who serve in a customer service support role.
ART received an Authority to Operate in compliance with the Department of Defense Information Assurance
Certification and Accreditation Process on June 2, 2012. The system undergoes an annual risk assessment
to ensure protective controls are maintained during the lifecycle of the system. ART maintains a Privacy
Impact Assessment on file with the TMA Privacy and Civil Liberties Office. (Full PIA previously submitted and
approved in 2010).
Information may be collected from active duty service members and retirees of the seven uniformed
services, their family members, survivors, members of the National Guard and Reserves and their families,
others who are registered in the Defense Enrollment Eligibility Reporting System (DEERS), and providers.
The type of personal information collected includes:
First and last name
Date of birth
Social Security Number
DoD Benefits Number
Mailing address
Phone numbers (e.g.., home, cell, work, fax);
E-mail address
Beneficiary's Current Plan/Program (e.g.., Prime, Standard, Extra, etc.)
Beneficiary's Category (e.g.., active duty, retired, etc.)
Sponsor's Branch of Service
Rank/Grade
ICD-9 Diagnosis Codes
CPT Codes
Anecdotal notes
TRICARE claims and debt collection information if required to handle a case (name of provider, date of
service, costs, and debt collection agency identifying information).
The fields above are not mandatory and are only collected if needed to assist the beneficiary in resolving his
or her TRICARE issue.
TRICARE Management Activity/Beneficiary Education & Support is the owner of the application. The
application is hosted on one site (HA/TMA) but is web-based and can be accessed by authorized users.
TRICARE Management Activity/Beneficiary Education & Support
Defense Health Headquarters (DHHQ)
7700 Arlington Blvd., Suite 5101
Falls Church, VA 22042-5101
(703) 681-1770

DD FORM 2930 NOV 2008

Page 4 of 19

(2) Briefly describe the privacy risks associated with the PII collected and how these risks are
addressed to safeguard privacy.
The privacy risks associated with the personally identifiable information (PII) and protected health information (PHI)
collected are the unauthorized release of PII/PHI data to include identity theft, sharing of PII/PHI with those who
have no need to know, unsolicited marketing, and compromise of sensitive information.
These privacy risks have been mitigated through physical, technical, and administrative controls. The application is
DoD Information Assurance Certification and Accreditation Process certified.

h. With whom will the PII be shared through data exchange, both within your DoD Component and
outside your Component (e.g., other DoD Components, Federal Agencies)? Indicate all that apply.
Within the DoD Component.
Specify.

Internal TMA organizations, Health Affairs, Personnel & Readiness

Other DoD Components.

Specify.

Uniformed Services (Army, Air Force, Navy, Marines, NOAA, Coast Guard,
and Public Health Services), military treatment facilities, Family Support
Services, Data Manpower Defense Center

Other Federal Agencies.

Specify.
State and Local Agencies.

Specify.
Contractor (Enter name and describe the language in the contract that safeguards PII.)

Specify.

Authorized users within the Managed Care Support Contractors, TRICARE Pharmacy
Contractor, TRICARE Dental Program Contractor, TRICARE Retiree Dental Program
Contractor, Overseas Contractor, and TRICARE Dual Eligible Fiscal Intermediary
Contractor
All contractors are expected to adhere to:
TRICARE Operations Manual Chapter 1 Section 5 Compliance with Federal Statutes
TRICARE Operations Manual Chapter 21 Section 3 Privacy of Individually Identifiable
Health Information

Other (e.g., commercial providers, colleges).

Specify.
i. Do individuals have the opportunity to object to the collection of their PII?
Yes

No

(1) If "Yes," describe method by which individuals can object to the collection of PII.
DD FORM 2930 NOV 2008

Page 5 of 19

All PII/PHI collected is voluntarily given by the beneficiary. At any time during the case resolution process,
individuals may object to the collection of PII/PHI via verbal or written notice. Individuals will be informed
that, without PII/PHI, the authorized user may not be able to assist in case resolution, and that answers to
questions/concerns would be generalities regarding the topic at hand.

(2) If "No," state the reason why individuals cannot object.

j. Do individuals have the opportunity to consent to the specific uses of their PII?
Yes

No

(1) If "Yes," describe the method by which individuals can give or withhold their consent.
Individuals can verbally or in writing consent or authorize secondary uses of their PII/PHI in accordance with
the Privacy Act and Health Insurance Portability and Accountability Act (HIPAA). In addition, a process is in
place for individuals to access, question, and correct the PII/PHI in the application by means of the HIPAA
Privacy Rule, Freedom of Information Act or a Privacy Act request.
PII/PHI are used and disclosed in accordance with the Privacy Act and HIPAA. These regulatory acts
provide individuals with the avenue for obtaining and granting access to information.

(2) If "No," state the reason why individuals cannot give or withhold their consent.

k. What information is provided to an individual when asked to provide PII data? Indicate all that
apply.
Privacy Act Statement

Privacy Advisory

Other

None

Describe AUTHORITY: 10 U.S.C. Chapter 55, Medical and Dental Care; 38 U.S.C. Chapter 17, Hospital,
each
Nursing Home, Domiciliary, and Medical Care; 32 CFR Part 199, Civilian Health and Medical
Page 6 of 19
DD FORM 2930 NOV 2008

applicable Program of the Uniformed Services (CHAMPUS); DoDI 6015.23, Delivery of Healthcare at Military
format.
Treatment Facilities: Foreign Service Care; Third-Party Collection; Beneficiary Counseling and
Assistance Coordinators (BCACs); and E.O. 9397 (SSN), as amended.
PURPOSE: To collect information from individuals for the purposes of resolving questions and issues
related to TRICARE and determining care authorization for select service members.
ROUTINE USES: Your records may be disclosed to third parties, which may include private
providers, other federal agencies, and collection agencies, in order to resolve any TRICARE-related
questions . Use and disclosure of your records outside of DoD may also occur in accordance with 5
U.S.C. 552a(b) of the Privacy Act of 1974, as amended, which incorporates the DoD Blanket Routine
Uses published at: http://dpclo.defense.gov/privacy/SORNs/blanket_routine_uses.html.
Any protected health information (PHI) in your records may be used and disclosed generally as
permitted by the HIPAA Privacy Rule (45 CFR Parts 160 and 164), as implemented within DoD by
DoD 6025.18-R. Permitted uses and discloses of PHI include, but are not limited to, treatment,
payment, and healthcare operations.
DISCLOSURE: Voluntary. If you choose not to provide your information, no penalty may be
imposed, but we may not be able to resolve your concerns, issue authorizations, or provide specific
answers to your questions.

NOTE:
Sections 1 and 2 above are to be posted to the Component's Web site. Posting of these
Sections indicates that the PIA has been reviewed to ensure that appropriate safeguards are in
place to protect privacy.
A Component may restrict the publication of Sections 1 and/or 2 if they contain information that
would reveal sensitive information or raise security concerns.

DD FORM 2930 NOV 2008

Page 7 of 19