Information Collection

388 Dept of Labor EBSA Q's FINAL 389 Tricare survey Outpatient 390 Tricare survey Inpatient

IC 195573 under ICR 200908-1090-001 · OMB 1090-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 388 Dept of Labor 388 Dept of Labor EBSA Q's FINAL 389 Tricare survey Outpatient 390 Tricare survey Inpatient	Form
388 Dept of Labor 388 Dept of Labor EBSA Questionnaire FINAL 2010 388 Dept of Labor EBSA Questionnaire FINAL.docx	Form
389 Tricare survey 389 Tricare survey Outpatient 2010 389 Tricare survey Outpatient.doc	Form
390 Tricare survey 390 Tricare survey Inpatient 2010 390 Tricare survey Inpatient.doc	Form

IC Title:

388 Dept of Labor EBSA Q's FINAL 389 Tricare survey Outpatient 390 Tricare survey Inpatient

Agency IC Tracking Number:

388-390

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	388 Dept of Labor EBSA Questionnaire FINAL	388 Dept of Labor EBSA Questionnaire FINAL	2010 388 Dept of Labor EBSA Questionnaire FINAL.docx	No	Paper Only
Form	389 Tricare survey Outpatient	389 Tricare survey Outpatient	2010 389 Tricare survey Outpatient.doc	No	Paper Only
Form	390 Tricare survey Inpatient	390 Tricare survey Inpatient	2010 390 Tricare survey Inpatient.doc	No	Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 750

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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