Professional Qualifictions, Medical and Peer Reviewers

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0005 can be found here:

Documents and Forms

Document Name Document Type
Form CHAMPUS FORM 780 Professional Qualifictions, Medical and Peer Reviewers Form
CHAMPUS FORM 780 Professional Qualifications Medical/Peer Reviewers CHAMPUSFORM780.pdf Form
OPS MANUAL 6010.51 CH13.pdf TRICARE Operations Manual 6010.15-M IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Professional Qualifictions, Medical and Peer Reviewers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CHAMPUS FORM 780	Professional Qualifications Medical/Peer Reviewers	CHAMPUSFORM780.pdf		No		Paper Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	60	0	60
Annual IC Time Burden (Hours)	15	0	15
Annual IC Cost Burden (Dollars)	750	750	0

Documents for IC

Title	Document	Date Uploaded
TRICARE Operations Manual 6010.15-M	OPS MANUAL 6010.51 CH13.pdf	08/31/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.