TRICARE: Select Survey of Civilian Providers

ICR 202201-0720-001

OMB: 0720-0031

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement B
2022-02-18
Supporting Statement A
2022-02-25
IC Document Collections
ICR Details
0720-0031 202201-0720-001
Received in OIRA 201811-0720-001
DOD/DODOASHA 0720-0031
TRICARE: Select Survey of Civilian Providers
Revision of a currently approved collection   No
Regular 02/25/2022
  Requested Previously Approved
36 Months From Approved 02/28/2022
50,000 20,000
4,167 1,667
139,958 48,000

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 legislative requirements.

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

Not associated with rulemaking

  86 FR 72584 12/22/2021
87 FR 10345 02/24/2022
No

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

  Total Request 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 50,000 20,000 0 30,000 0 0
Annual Time Burden (Hours) 4,167 1,667 0 2,500 0 0
Annual Cost Burden (Dollars) 139,958 48,000 0 91,958 0 0
Yes
Miscellaneous Actions
No
The burden has increased due to an increase in the number of respondents.

$581,722
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
Sandra Dennis 703 681-8818 sandra.e.dennis4.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.
02/25/2022


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