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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0720-0008
ICR Reference No:
201905-0720-001
Status:
Historical Active
Previous ICR Reference No:
201602-0720-001
Agency/Subagency:
DOD/DODOASHA
Agency Tracking No:
Title:
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
08/26/2019
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/23/2019
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2022
36 Months From Approved
08/31/2019
Responses
3,040,100
0
148,033
Time Burden (Hours)
760,026
0
37,008
Cost Burden (Dollars)
5,510,181
0
268,310
Abstract:
These collection instruments serve as application for enrollment, disenrollment, and Primary Care Manager (PCM) Change for the Department of Defense's TRICARE Prime program. The information collected provides the necessary data to determine beneficiary eligibility, complete enrollment, change beneficiary's enrollment (new Primary Care Manager, enrolled region, add a dependent, etc.), or dis-enroll the beneficiary.
Authorizing Statute(s):
US Code:
10 USC 1099
Name of Law: Health Care Enrollment System
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
84 FR 10481
03/21/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 23038
05/21/2019
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form
2876-1, 2876-3, 2876-2
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form
,
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form
,
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change- phone
TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change- web portal
ICR Summary of Burden
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
3,040,100
148,033
0
0
2,892,067
0
Annual Time Burden (Hours)
760,026
37,008
0
0
723,018
0
Annual Cost Burden (Dollars)
5,510,181
268,310
0
0
5,241,871
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
In the past, only the burden for responses collected through the DD Form 2876 and the web portal were taken into consideration, not the responses via telephone. This oversight is now being corrected and the burden more accurately reflects the popular use of TRICARE Prime, specifically the enrollment, disenrollment, and primary care manager change form. In addition, ease of the online system and allowance of enrolling via telephone has caused a significant increase from past collections. However, the individual burden has decreased from 30 minutes to 15 minutes due to revisions of the form.
Annual Cost to Federal Government:
$16,221,845
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Stacy Brenner 571 372-7574 stacy.j.brenner.ctr@mail.mil
Common Form ICR:
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:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(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;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
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.
Certification Date:
05/23/2019
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