TRICARE: Standard Survey of Civilian Providers

ICR 201112-0720-002

OMB: 0720-0031

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement B
2008-09-04
Supporting Statement A
2008-09-04
IC Document Collections
IC ID
Document
Title
Status
5609 Unchanged
ICR Details
0720-0031 201112-0720-002
Historical Active 200809-0720-001
DOD/DODOASHA
TRICARE: Standard Survey of Civilian Providers
Extension without change of a currently approved collection   No
Regular
Approved without change 03/29/2012
Retrieve Notice of Action (NOA) 12/29/2011
Approved consistent with the prior terms of clearance.
  Inventory as of this Action Requested Previously Approved
03/31/2015 36 Months From Approved 03/31/2012
40,000 0 40,000
3,333 0 3,333
0 0 0

This survey will gather data on providers (physicians and now mental health providers) to assess the extent to which they are aware of the over all TRICARE program, accept new TRICARE Standard patients specifically and the extent to which these physicians accept Medicare patients. The information gathered through this project will be used to generate reports to address the legislative requirements specified in Section 711 of the FY08 NDAA.

PL: Pub.L. 108 - 181 711 Name of Law: null
   PL: Pub.L. 108 - 136 723 Name of Law: null
  
None

Not associated with rulemaking

  72 FR 67595 11/29/2007
73 FR 42329 07/21/2008
No

1
IC Title Form No. Form Name
TRICARE: Standard Survey of Civilian Providers

  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 40,000 40,000 0 0 0 0
Annual Time Burden (Hours) 3,333 3,333 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$555,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Robert Cushing 703 604-6269 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/29/2011


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