OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Application for TRICARE-Provider Status: CORPORATE SERVICES PROVIDER

IC 5593 under ICR 202511-0720-002 · OMB 0720-0020.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Application for TRICARE-Provider Status: CORPORATE SERVICES PROVIDER
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form DD Form 3030 Corporate Services Provider Application for TRICARE Provider Status ddx644_20160112.PDF https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd3030.pdf Yes Yes Fillable Fileable Signable

Defense and National Security Operational Defense

 

8,100 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 8,100 0 0 0 0 8,100
Annual IC Time Burden (Hours) 2,700 0 0 0 0 2,700
Annual IC Cost Burden (Dollars) 51,516 0 0 0 0 51,516

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.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].