Information Collection

TRICARE: Standard Survey of Civilian Providers

IC 5609 under ICR 202201-0720-001 · OMB 0720-0031.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0031 can be found here:

Documents and Forms

Documents and forms in this information collection
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 - 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 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	Other-Telephone Script
0720-0031_TSS-P 2019 Telephone Script_10.15.2018.docx	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_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
0720-0031_TSS-P 2019 Internet Survey Screenshots_10.15.2018.docx www.health.mil/healthsurveys	Other-Internet Survey Screenshots

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:

table that charts list of 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		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: 50,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 18 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	50,000	30,000	20,000
Annual IC Time Burden (Hours)	4,167	2,500	1,667
Annual IC Cost Burden (Dollars)	139,958	91,958	48,000

Documents for IC

table that charts IC Documents
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.