TRICARE: Standard Survey of Civilian Providers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
DMDC Recommendation Letter for TRICARE Standard Survey of Civilian Providers 11jun2015 (3).PDF	Supplementary Document	Uploaded 2015-09-04	Available
0720-0031_OMB Part B_TSS rev post DMDC review_28 May 2015_Clean.DOC	Supporting Statement B	Uploaded 2015-09-04	Available
0720-0031_OMB Supporting Statement - Part A_TSS 28 May 2015 Response to DMDC Review_Clean.DOC	Supporting Statement A	Uploaded 2015-09-04	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
5609	TRICARE: Standard Survey of Civilian Providers	Other-Instrument	Modified

ICR Details

OMB Control No: 0720-0031	ICR Reference No: 201507-0720-002
Status: Historical Active	Previous ICR Reference No: 201112-0720-002
Agency/Subagency: DOW/DODOASHA	Agency Tracking No:
Title: TRICARE: Standard Survey of Civilian Providers
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/06/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/04/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2018	36 Months From Approved
Responses	50,000	0	0
Time Burden (Hours)	4,167	0	0
Cost Burden (Dollars)	120,000	0	0

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Abstract: 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.

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Authorizing Statute(s): PL: Pub.L. 108 - 181 711
   PL: Pub.L. 108 - 136 723
  

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:
	80 FR 35	01/02/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 43072	07/21/2015
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
TRICARE: Standard Survey of Civilian Providers

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ICR Summary of Burden

table that charts list of burden

	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	50,000	0	0	0	10,000	40,000
Annual Time Burden (Hours)	4,167	0	0	0	834	3,333
Annual Cost Burden (Dollars)	120,000	0	0	0	120,000	0

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: There has been an increase in the number of respondents.

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Annual Cost to Federal Government: $561,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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]? No

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: 09/04/2015

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