Information Collection

TRICARE Dual Eligible Fiscal Intermediary Contract Provider Satisfaction Survey

IC 191736 under ICR 201001-0720-001 · OMB 0720-0045.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
TDEFIC Provider Survey - final.pdf	Other-Survey
TDEFIC IVR Provider Survey questions - final.doc	Other-Survey

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 32 CFR 199

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			TDEFIC Provider Survey - final.pdf		No		Paper Only
Other-Survey			TDEFIC IVR Provider Survey questions - final.doc		No		Paper Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 46,800

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	46,800	46,800
Annual IC Time Burden (Hours)	11,700	11,700
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.