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Federal forms, ICRs, and supporting documents

Information Collection

TRICARE: Standard Survey of Civilian Providers

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

Documents and Forms
Document Name
Document Type
Other-Physician Survey
Other-Physician Survey
Other-Mental Health Provider Survey
Other-Mental Health Provider Survey
Other-Telephone Script
Other-Telephone Script
Other-Internet Survey
Other-Internet Survey
Other-Internet Survey Screenshots
Other-Internet Survey Screenshots
Information Collection (IC) Details

View Information Collection (IC)

TRICARE: Standard Survey of Civilian Providers
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name 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

Defense and National Security Operational Defense

 

50,000 0
   
Individuals or Households
 
   18 %

  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 50,000 0 30,000 0 0 20,000
Annual IC Time Burden (Hours) 4,167 0 2,500 0 0 1,667
Annual IC Cost Burden (Dollars) 139,958 0 91,958 0 0 48,000

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.