Certification of Non-Contributory TRICARE Supplement Insurance

Forms and Documents

Document	Type	Status	Availability
Supporting Statement Part A 0720-0004 FINAL.doc	Supporting Statement A	Uploaded 2017-06-30	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
191500	Certification of Non-Contributory TRICARE Supplement Insurance		Modified

ICR Details

OMB Control No: 0720-0044	ICR Reference No: 201706-0720-001
Status: Historical Active	Previous ICR Reference No: 201311-0720-001
Agency/Subagency: DOD/DODOASHA	Agency Tracking No: 0720-0044
Title: Certification of Non-Contributory TRICARE Supplement Insurance
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/15/2017
	Date Received in OIRA: 06/30/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2020	36 Months From Approved
Responses	1,500	0	0
Time Burden (Hours)	250	0	0
Cost Burden (Dollars)	8,750	0	0

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Abstract: Employers may no longer offer TRICARE supplemental insurance plans as part of an employee benefit package unless the plan is not paid for in whole or in part by the employer (i.e., is non-contributory). If such plans are offered, the employer must certify in writing that they did not provide any payment for the benefit, nor receive any direct or indirect consideration or compensation for offering the benefit; their only involvement is providing the administrative support.The employer shall provide this certification via letter to the DoD only upon request The certification document will be used to verify regulatory compliance.

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Authorizing Statute(s): US Code: 10 USC 1097c 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:
	81 FR 76927	11/04/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 29279	06/28/2017
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Certification of Non-Contributory TRICARE Supplement Insurance

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ICR Summary 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	1,500	0	0	0	0	1,500
Annual Time Burden (Hours)	250	0	0	0	0	250
Annual Cost Burden (Dollars)	8,750	0	0	0	0	8,750

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: $90,000

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 06/30/2017

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