Application for TRICARE-Provider Status: Corporate Services Provider

OMB 0720-0020

The information collection requirement is necessary to ensure that applicants for TRICARE-Provider Status meet the conditions for authorization as a TRICARE Corporate Services Provider. The collected nformation will be used by TRICARE contractors to process claims and verify authorization status.

The latest form for Application for TRICARE-Provider Status: Corporate Services Provider expires 2022-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form DD Form 3030 Application for TRICARE-Provider Status: CORPORATE SERVICES PROVIDER Form
0720-0020_SSA_10.25.2022.docx Supporting Statement A
Application for TRICARE-Provider Status: CORPORATE SERVICES PROVIDER Form

All Historical Document Collections

202208-0720-001 Approved without change	Revision of a currently approved collection	2022-10-27
201908-0720-003 Approved without change	Revision of a currently approved collection	2019-08-29
201604-0720-001 Approved without change	Reinstatement with change of a previously approved collection	2016-04-07
201207-0720-005 Improperly submitted	Reinstatement without change of a previously approved collection	2012-07-05
201001-0720-003 Disapproved and continue	Extension without change of a currently approved collection	2010-01-31
200609-0720-001 Approved without change	Reinstatement without change of a previously approved collection	2006-09-29
200306-0720-001 Approved without change	Reinstatement without change of a previously approved collection	2003-06-26
199902-0720-001 Approved without change	New collection (Request for a new OMB Control Number)	1999-02-23