Information Collection

TRICARE Retail Refunds Request User Account Access

IC 5612 under ICR 202207-0720-001 · OMB 0720-0032.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0032 can be found here:

Documents and Forms

Document Name Document Type
TRRWS User Account Access screenshots_2022.docx Other-Online system
TRRWS User Account Access screenshots_2022.docx Other-Online system
TRRWS Homepage 9.23 v2.pdf Privacy Advisory and ADN Screenshot IC Document
TRRWS Homepage 9.23 v2.pdf Privacy Advisory and ADN Screenshot IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	TRICARE Retail Refunds Request User Account Access	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 32 CFR 199.21

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Online system			TRRWS User Account Access screenshots_2022.docx		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: 300	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,200	0	1,200
Annual IC Time Burden (Hours)	9,600	0	9,600
Annual IC Cost Burden (Dollars)	474,240	89,760	384,480

Documents for IC

Title	Document	Date Uploaded
Privacy Advisory and ADN Screenshot	TRRWS Homepage 9.23 v2.pdf	09/30/2022

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