Information Collection

2019 233 MHS Genesis Beneficiaries Feedback Survey

IC 237055 under ICR 201805-1090-003 · OMB 1090-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 233 2019 233 MHS Genesis Beneficiaries Feedback Survey	Form and Instruction
233 2019 233 MHS Genesis Beneficiaries Feedback Survey 2019 233 MHS Genesis Beneficiaries Feedback Survey.docx	Form and Instruction
1090-0008 Generic Clearance Request Form 09132018 July 8 2019 TRICARE MH.pdf 1090-0008 Generic Clearance Request Form 09132018 July 8 2019 TRICARE MH	IC Document

IC Title:

2019 233 MHS Genesis Beneficiaries Feedback Survey

Agency IC Tracking Number:

233

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	233	2019 233 MHS Genesis Beneficiaries Feedback Survey	2019 233 MHS Genesis Beneficiaries Feedback Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
1090-0008 Generic Clearance Request Form 09132018 July 8 2019 TRICARE MH	1090-0008 Generic Clearance Request Form 09132018 July 8 2019 TRICARE MH.pdf	07/23/2019

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