TRICARE: Select Survey of Civilian Providers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0720-0031_SS-A_11.23.18.docx	Supporting Statement A	Uploaded 2018-11-23	Available
0720-0031_SS-B_11.21.18.doc	Supporting Statement B	Uploaded 2018-11-21	Available

IC Document Collections

Information collection document groups

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

ICR Details

OMB Control No: 0720-0031	ICR Reference No: 201811-0720-001
Status: Active	Previous ICR Reference No: 201507-0720-002
Agency/Subagency: DOD/DODOASHA	Agency Tracking No: 0720-0031
Title: TRICARE: Select Survey of Civilian Providers
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/12/2019
	Date Received in OIRA: 11/26/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	36 Months From Approved	02/28/2019
Responses	20,000	0	50,000
Time Burden (Hours)	1,667	0	4,167
Cost Burden (Dollars)	48,000	0	120,000

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Abstract: This survey gathers data on providers (physicians and mental health providers) to assess the extent to which they are aware of the over all TRICARE program, accept new TRICARE Select 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 in Section 712 of FY15 NDAA.

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Authorizing Statute(s): PL: Pub.L. 112 - 181 712 Name of Law: NDAA FY15
  

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:
	83 FR 47891	09/21/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 59367	11/23/2018
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	20,000	50,000	0	0	-30,000	0
Annual Time Burden (Hours)	1,667	4,167	0	0	-2,500	0
Annual Cost Burden (Dollars)	48,000	120,000	0	0	-72,000	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: We have reduced the estimated burden based on historical response rates of 40 % to this survey. The burden estimate has decreased since the previous approval from 4,167 total annual hours to the current 1,667 hours. The change of hours is because the previous estimate was based upon the total survey sample. The current estimate is based upon 20,000 annual completed surveys.

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Annual Cost to Federal Government: $569,570

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

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: 11/26/2018

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