TRICARE: Select Survey of Civilian Providers

ICR 201811-0720-001

OMB: 0720-0031

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2018-11-23
Supporting Statement B
2018-11-21
IC Document Collections
ICR Details
0720-0031 201811-0720-001
Active 201507-0720-002
DOD/DODOASHA 0720-0031
TRICARE: Select Survey of Civilian Providers
Revision of a currently approved collection   No
Regular
Approved without change 02/12/2019
Retrieve Notice of Action (NOA) 11/26/2018
  Inventory as of this Action Requested Previously Approved
02/28/2022 36 Months From Approved 02/28/2019
20,000 0 50,000
1,667 0 4,167
48,000 0 120,000

This survey gathers data on providers (physicians and mental health providers) to assess the extent to which they are aware of the over all TRICARE program, accept new TRICARE Select patients specifically and the extent to which these physicians accept Medicare patients. The information gathered through this project will be used to generate reports to address the legislative requirements in Section 712 of FY15 NDAA.

PL: Pub.L. 112 - 181 712 Name of Law: NDAA FY15
  
None

Not associated with rulemaking

  83 FR 47891 09/21/2018
83 FR 59367 11/23/2018
No

1
IC Title Form No. Form Name
TRICARE: Standard Survey of Civilian Providers

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 20,000 50,000 0 0 -30,000 0
Annual Time Burden (Hours) 1,667 4,167 0 0 -2,500 0
Annual Cost Burden (Dollars) 48,000 120,000 0 0 -72,000 0
No
Yes
Miscellaneous Actions
We have reduced the estimated burden based on historical response rates of 40 % to this survey. The burden estimate has decreased since the previous approval from 4,167 total annual hours to the current 1,667 hours. The change of hours is because the previous estimate was based upon the total survey sample. The current estimate is based upon 20,000 annual completed surveys.

$569,570
Yes Part B of Supporting Statement
    No
    No
No
No
No
Uncollected
Kira Starks 571 372-4529 danikquia.k.starks.ctr@mail.mil

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/26/2018


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