| OMB Number | Title |
|---|
| 0720-0081 |
Reserve Component Health Coverage Request |
| 0720-0080 |
Leader Assessment of the DoD’s Toolkit for Managing Suicide-Related Events |
| 0720-0079 |
TRICARE Select Survey of Beneficiaries (TSS-B) |
| 0720-0078 |
The Health Care Survey of DoD Beneficiaries (HCSDB) |
| 0720-0077 |
TRICARE Inpatient Satisfaction Survey (TRISS) |
| 0720-0076 |
Fielding Successful Military Medical Products: Voice of the Industry Partner (VOIP) Survey |
| 0720-0075 |
Travis Air Force Base Exceptional Family Member Program (EFMP) Pilot Program Evaluation Survey |
| 0720-0074 |
Prescription Drop Off/Activation Form |
| 0720-0073 |
Restructure or Realignment of Military Medical Treatment Facilities |
| 0720-0072 |
Health Related Behaviors Survey |
| 0720-0071 |
Centralized Credentials and Quality Assurance System |
| 0720-0070 |
Childbirth and Breastfeeding Demonstration Survey |
| 0720-0069 |
DoD COVID-19 Vaccine Questionnaire |
| 0720-0068 |
COVID-19 Vaccine Screening and Immunization Documentation |
| 0720-0067 |
Personnel Accountability and Assessment for a Public Health Emergency |
| 0720-0066 |
Continued Health Care Benefit Program (CHCBP) Application |
| 0720-0065 |
Assessment of Real Warriors Campaign’s Impact on Negative Perceptions about Mental Health Conditions and Treatment and Awareness of Resources |
| 0720-0064 |
MHS GENESIS Patient Registration Module & Patient Portal |
| 0720-0063 |
Preservation of the Force and Family (POTFF) Spiritual Fitness Metrics |
| 0720-0062 |
Comparing Hospital Hand Hygiene in Liberia: Soap, Alcohol, and Hypochlorite |
| 0720-0061 |
TRICARE Select Enrollment, Disenrollment, and Change Form |
| 0720-0060 |
Assistance Reporting Tool (ART) |
| 0720-0059 |
Patient Centered Medical Home (PCMH) Staff Satisfaction Survey |
| 0720-0058 |
Department of Defense Suicide Event Report (DoDSer) |
| 0720-0057 |
Enterprise Blood Management System (EBMS) |
| 0720-0056 |
Screening and Monitoring of DoD Personnel Deployed to Ebola Outbreak Areas |
| 0720-0055 |
Third Party Collection Program (Insurance Information) |
| 0720-0054 |
ACAM2000® Myopericarditis Registry |
| 0720-0053 |
Active Duty Dental Program Claim Form |
| 0720-0052 |
Military Nurse Recruitment Surveys |
| 0720-0050 |
Retired Troops to Nurse Teachers Survey |
| 0720-0049 |
TRICARE Young Adult Application |
| 0720-0048 |
Award Fee Provider Survey |
| 0720-0047 |
An Outcome Evaluation of the SOS Signs of Suicide Prevention Program |
| 0720-0046 |
Women, Infants and Children Overseas Participant Satisfaction Survey |
| 0720-0045 |
TRICARE Dual Eligible Fiscal Intermediary Contract Provider Satisfaction Survey |
| 0720-0044 |
Certification of Non-Contributory TRICARE Supplement Insurance |
| 0720-0043 |
Retention of Behavior Health Providers Survey |
| 0720-0042 |
Researcher Responsibilities Acknowledgement |
| 0720-0041 |
Defense Medical Human Resources System Internet (DMHRSi) |
| 0720-0040 |
Facilitating Provider Acceptance of TRICARE Standard |
| 0720-0039 |
TRICARE Satisfaction Survey of Network Providers |
| 0720-0038 |
Public Perception of the Military Health System (Focus Groups) |
| 0720-0035 |
TRICARE Dental Program (TDP) Claim Form |
| 0720-0034 |
Defense Health Agency Patient Safety Culture Survey |
| 0720-0032 |
TRICARE Retail Refunds Request User Account Access |
| 0720-0031 |
TRICARE: Select Survey of Civilian Providers |
| 0720-0030 |
Women, Infants, and Children Overseas - Eligibility Determination |
| 0720-0029 |
Prospective Studies of US Military Forces: The Millennium Cohort Study |
| 0720-0028 |
TRICARE Plus Enrollment and Disenrollment Application Forms |
| 0720-0027 |
Health Evaluation Assessment Review (HEAR 2.X) |
| 0720-0025 |
TRICARE for Life Beneficiary Information Update Form |
| 0720-0024 |
Survey of Prescribers in Military Treatment Facilities and TRICARE Contracts |
| 0720-0023 |
Pharmacy Redesign Pilot Program |
| 0720-0022 |
DoD Active Duty/Reserve Forces Dental Examination |
| 0720-0021 |
Armed Forces Health Professions Loan Repayment Program Loan Information and Verification Form |
| 0720-0020 |
Application for TRICARE-Provider Status: Corporate Services Provider |
| 0720-0018 |
TRICARE Senior Prime Enrollment Application Form |
| 0720-0017 |
Diagnosis Related Groups (DRG) Reimbursement (Two Parts) |
| 0720-0016 |
Women's Health Care in the Field Environment |
| 0720-0015 |
TRICARE Retiree Dental Program Enrollment Application |
| 0720-0013 |
Health Insurance Claims Form, UB-04 CMS 1450 |
| 0720-0012 |
Department of Defense Khamisiyah Survey |
| 0720-0011 |
Epidemiologic Studies of Morbidity Among Gulf War Veterans: A Search for Etiologic Agents and Risk Factors, Seabee Health Study (Study 5) |
| 0720-0010 |
Epidemiologic Studies of Morbidity Among Gulf War Veterans: A Search for Etiologic Agents and Risk Factors |
| 0720-0009 |
Provider Certification Requirements-Corporate Services Provider Class; Occupational Therapists |
| 0720-0008 |
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change |
| 0720-0007 |
CHAMPUS MENTAL HEALTH PROGRAM COST REIMBURSEMENT |
| 0720-0006 |
TRICARE DoD/CHAMPUS Medical Claim Patient's Request for Medical Payment |
| 0720-0005 |
Professional Qualifications, Medical and Peer Reviewers |
| 0720-0004 |
TRICARE PROGRAM EVALUATION SURVEY |
| 0720-0003 |
Statement of Personal Injury: Possible Third Party Liability |
| 0720-0002 |
CHAMPUS CHIROPRACTIC CARE DEMONSTRATION BENEFICIARY SURVEY |
| 0720-0001 |
Health Insurance Claim Form |