Application for CHAMPUS-Provider Status: CORPORATE SERVICES PROVIDER

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
32cfr199.6.pdf	Supplementary Document	Uploaded 2006-09-29	Available
1999 Final Rule.pdf	Supplementary Document	Uploaded 2006-09-29	Available
0720-0020 SS PART A.pdf	Supporting Statement A	Uploaded 2010-01-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
5593	Application for CHAMPUS-Provider Status: CORPORATE SERVICES PROVIDER	Other-Application	Modified

ICR Details

OMB Control No: 0720-0020	ICR Reference No: 201001-0720-003
Status: Historical Inactive	Previous ICR Reference No: 200609-0720-001
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: Application for CHAMPUS-Provider Status: CORPORATE SERVICES PROVIDER
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Disapproved and continue	Conclusion Date: 11/09/2010
	Date Received in OIRA: 01/31/2010
Terms of Clearance: In accordance with 5 CFR 1320, this information collection is disapproved. The agency submitted their last supporting statement. It is incorrect. The agency may re-submit the collection immediately with a new, correct supporting statement.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2010	36 Months From Approved	11/30/2010
Responses	200	0	200
Time Burden (Hours)	200	0	200
Cost Burden (Dollars)	4,400	0	4,400

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Abstract: The information collection requirement is necessary to ensure that applicants for CHAMPUS-Provider Status meet the conditions for authorization as a CHAMPUS Corporate Services Provider. The collected nformation will be used by CHAMPUS contractors to process claims and verify authorization status.

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Authorizing Statute(s): US Code: 5 USC 301 Name of Law: null
   US Code: 10 USC Chapter 55 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 57154	11/04/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 57154	11/04/2009
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Application for CHAMPUS-Provider Status: CORPORATE SERVICES PROVIDER

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

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: $11,070

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? No

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)? No

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: 01/31/2010

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