TRICARE Select Survey of Beneficiaries (TSS-B)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0720-TSSB_SSB_2.13.2024.docx	Supporting Statement B	Uploaded 2024-02-20	Repair queued
TSS_B reminder postcard_2023.pdf	Supplementary Document	Uploaded 2024-01-23	Repair queued
TSS_B pre_note letter_2023.pdf	Supplementary Document	Uploaded 2024-01-23	Repair queued
TSS_B cover letter_2023.pdf	Supplementary Document	Uploaded 2024-01-23	Repair queued
0720-TSSB_SSA_2.13.2024.docx	Supporting Statement A	Uploaded 2024-02-20	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
264614	TRICARE Select Survey of Beneficiaries	Other-Survey	New

ICR Details

OMB Control No: 0720-0079	ICR Reference No: 202401-0720-003
Status: Active	Previous ICR Reference No:
Agency/Subagency: DOW/DODOASHA	Agency Tracking No: 0720-TSSB
Title: TRICARE Select Survey of Beneficiaries (TSS-B)
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/03/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/20/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2027	36 Months From Approved
Responses	5,000	0	0
Time Burden (Hours)	1,250	0	0
Cost Burden (Dollars)	33,100	0	0

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Abstract: The TSS-B is a population-based survey, not a healthcare encounter-based survey; this makes it unique as the only survey of the entire TSS-B beneficiary population regardless of whether they have had a recent health care encounter. TSS-B is the sole source for Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey of patient experience results for the TSS beneficiary population. This information collection is used to evaluate and identify issues related to patient experience and access to care for TRICARE Select beneficiaries.

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Authorizing Statute(s): PL: Pub.L. 102 - 484 724 Name of Law: National Defense Authorization Act for Fiscal Year 1993
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 78338	11/15/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 10055	02/13/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
TRICARE Select Survey of Beneficiaries

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	5,000	0	0	5,000	0	0
Annual Time Burden (Hours)	1,250	0	0	1,250	0	0
Annual Cost Burden (Dollars)	33,100	0	0	33,100	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is an existing collection currently in use without an OMB Control Number.

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Annual Cost to Federal Government: $777,391

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/20/2024

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