Information Collection

TRICARE Inpatient Satisfaction Survey (Adult)

IC 264698 under ICR 202401-0720-004 · OMB 0720-0077.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
TRISS Adult Survey.docx	Other-Survey
TRISS Adult Survey.docx	Other-Survey

IC Title:

Agency IC Tracking Number:

0720-TRSS

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			TRISS Adult Survey.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	60,600	60,600
Annual IC Time Burden (Hours)	7,070	7,070
Annual IC Cost Burden (Dollars)	210,403	210,403

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.