Information Collection

TRICARE Select Survey of Beneficiaries

IC 264614 under ICR 202401-0720-003 · OMB 0720-0079.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
TSS-B questionnaire FY24.docx	Other-Survey
TSSB Survey 2024-05-01.docx	Other-Survey

IC Title:

Agency IC Tracking Number:

0720-TSSB

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			TSSB Survey 2024-05-01.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 62 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	33,100	33,100

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.