Information Collection

TRICARE: Standard Survey of Civilian Providers

IC 5609 under ICR 201507-0720-002 · OMB 0720-0031.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0031 can be found here:

Documents and Forms

Document Name Document Type
0720-0031 Collection Instrument 7.16.2015.PDF Other-Instrument
0720-0031_Attch 7c DoDCV_CATI_PH_grp101_103113.DOCX Instruction
0720-0031_Attch 7d DoDCV_CATI_BH_grp201_103113.DOCX Instruction
2015 DoDCV_BH060415 1ST MAILING.DOCX Other-Instructions and Instrument
2015 DoDCV_BH060415 2ND MAILING.DOCX Other-Instructions and Instrument
2015 DoDCV_PH060415 1ST MAILING.DOCX Other-Instructions and Instrument
2015 DoDCV_PH060415 2ND MAILING.DOCX Other-Instructions and Instrument
DoDCV_CATI_BH_grp201_060415.DOCX Instruction
DoDCV_CATI_PH_grp101_060415.DOCX Instruction
PL 108-136, Sec 723.doc PL 108-136, Sec 723 IC Document
NDAA FY06, Sec 711.doc NDAA FY06, Sec 711 IC Document
PL 108-181, Sec 711.doc PL 108-181, Sec 711 IC Document
MAP.doc MAP IC Document
Summary of Survey Results (2005,2006,2007).doc Summary of Survey Results IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	TRICARE: Standard Survey of Civilian Providers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Instrument	0720-0031 Collection Instrument 7.16.2015.PDF	Yes	Yes	Fillable Fileable
Instruction	0720-0031_Attch 7c DoDCV_CATI_PH_grp101_103113.DOCX	No		Paper Only
Instruction	0720-0031_Attch 7d DoDCV_CATI_BH_grp201_103113.DOCX	No		Paper Only
Other-Instructions and Instrument	2015 DoDCV_BH060415 1ST MAILING.DOCX	No		Paper Only
Other-Instructions and Instrument	2015 DoDCV_BH060415 2ND MAILING.DOCX	No		Paper Only
Other-Instructions and Instrument	2015 DoDCV_PH060415 1ST MAILING.DOCX	No		Paper Only
Other-Instructions and Instrument	2015 DoDCV_PH060415 2ND MAILING.DOCX	No		Paper Only
Instruction	DoDCV_CATI_BH_grp201_060415.DOCX	No		Paper Only
Instruction	DoDCV_CATI_PH_grp101_060415.DOCX	No		Paper Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	50,000	10,000	40,000
Annual IC Time Burden (Hours)	4,167	834	3,333
Annual IC Cost Burden (Dollars)	120,000	120,000	0

Documents for IC

Title	Document	Date Uploaded
PL 108-136, Sec 723	PL 108-136, Sec 723.doc	09/01/2008
NDAA FY06, Sec 711	NDAA FY06, Sec 711.doc	09/01/2008
PL 108-181, Sec 711	PL 108-181, Sec 711.doc	09/01/2008
MAP	MAP.doc	09/01/2008
Summary of Survey Results	Summary of Survey Results (2005,2006,2007).doc	09/04/2008

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