Application for TRICARE-Provider Status: CORPORATE SERVICES PROVIDER

Application for TRICARE-Provider Status: CORPORATE SERVICES PROVIDER

OMB: 0720-0020

IC ID: 5593

Information Collection (IC) Details

View Information Collection (IC)

Application for TRICARE-Provider Status: CORPORATE SERVICES PROVIDER
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form DD Form 3030 Corporate Services Provider Application for TRICARE Provider Status ddx644_20160112.PDF https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd3030.pdf Yes Yes Fillable Fileable Signable

Defense and National Security Operational Defense

 

335 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 335 0 35 0 0 300
Annual IC Time Burden (Hours) 112 0 12 0 0 100
Annual IC Cost Burden (Dollars) 2,087 0 377 0 0 1,710

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