Information Collection

TRICARE Retail Refunds Request User Account Access

IC 5612 under ICR 202511-0720-004 · OMB 0720-0032.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 32 CFR 199.21

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-Online system					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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	9,600	9,600
Annual IC Cost Burden (Dollars)	474,240	474,240

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Privacy Advisory and ADN Screenshot		09/30/2022

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

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