Viability of TRICARE Standard Survey

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
5607	Viability of TRICARE Standard Survey	Migrated

ICR Details

OMB Control No: 0720-0031	ICR Reference No: 200403-0720-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: Viability of TRICARE Standard Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 04/09/2004
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/19/2004
	Date Received in OIRA: 03/30/2004
Terms of Clearance: Approved for 90 days consistent with DOD memos submitted to OMB on 04/19/04. DOD will conduct a survey pilot in the first 6 market areas during the 90 day emergency approval period and will report results to OMB prior to resubmitting the survey for regular approval. If the survey achieves less than an 80% response rate DOD will incorporate a non- response bias analysis into the request for regular PRA approval. Additionally, DOD will evaluate the use of alternative survey formats which utilize best practices such as mail/fax-back format. Also, strategies for additional reminders or refusal conversion should be evaluated.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2004	07/31/2004
Responses	9,360	0	0
Time Burden (Hours)	2,340	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The TRICARE Management Activity (TMA) under the authority of the Office of the Assistant Secretary of Defense (Health Affairs)/TMA Office of the Deputy Assistant Secretary of Defense, will undertake an evaluation of the DOD's TRICARE Standard Health Care Option, focusing on the issues identified in Section 723 of the FY04NDAA. These issues address the interests of Congress in determining the number of civilian providers who accept TRICARE rates as payment in full for health care services. Telephone surveys of civilian health care providers will be conducted in TRICARE market areas to determine how many providers are ...

Emergency Justfication:

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Viability of TRICARE Standard Survey

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	9,360	0	0	9,360	0	0
Annual Time Burden (Hours)	2,340	0	0	2,340	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/30/2004

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