TRICARE: Standard Survey of Civilian Providers

TRICARE: Select Survey of Civilian Providers

⚠️ Notice: This information collection may be referencing outdated material.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_TSS-P 2019 Mailing Instrument - Physicians_10.15.2018.docx www.health.mil/healthsurveys Other-Physician Survey
0720-0031_TSS-P 2019 Mailing Instrument - Behavioral Health_10.15.2018.docx www.health.mil/healthsurveys Other-Mental Health Provider Survey
0720-0031_TSS-P 2019 Telephone Script_10.15.2018.docx www.health.mil/healthsurveys Other-Telephone Script
0720-0031_TSS-P 2019 Internet Survey_10.15.2018.docx www.health.mil/healthsurveys Other-Internet Survey
0720-0031_TSS-P 2019 Internet Survey Screenshots_10.15.2018.docx www.health.mil/healthsurveys Other-Internet Survey Screenshots

Information Collection (IC) Details

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Physician Survey	0720-0031_TSS-P 2019 Mailing Instrument - Physicians_10.15.2018.docx	http://www.health.mil/healthsurveys	Yes	Yes	Fillable Fileable
Other-Mental Health Provider Survey	0720-0031_TSS-P 2019 Mailing Instrument - Behavioral Health_10.15.2018.docx	http://www.health.mil/healthsurveys	Yes	Yes	Fillable Fileable
Other-Telephone Script	0720-0031_TSS-P 2019 Telephone Script_10.15.2018.docx	http://www.health.mil/healthsurveys	No		Paper Only
Other-Internet Survey	0720-0031_TSS-P 2019 Internet Survey_10.15.2018.docx	http://www.health.mil/healthsurveys	Yes	Yes	Fillable Fileable
Other-Internet Survey Screenshots	0720-0031_TSS-P 2019 Internet Survey Screenshots_10.15.2018.docx	http://www.health.mil/healthsurveys	Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 8 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	20,000	-30,000	50,000
Annual IC Time Burden (Hours)	1,667	-2,500	4,167
Annual IC Cost Burden (Dollars)	48,000	-72,000	120,000

Documents for IC

Title	Document	Date Uploaded
No associated records found

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