View Information Collection Request (ICR) Package
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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:
0720-0031
ICR Reference No:
201811-0720-001
Status:
Historical Active
Previous ICR Reference No:
201507-0720-002
Agency/Subagency:
DOD/DODOASHA
Agency Tracking No:
0720-0031
Title:
TRICARE: Select Survey of Civilian Providers
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
02/12/2019
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/26/2018
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2022
36 Months From Approved
02/28/2019
Responses
20,000
0
50,000
Time Burden (Hours)
1,667
0
4,167
Cost Burden (Dollars)
48,000
0
120,000
Abstract:
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.
Authorizing Statute(s):
PL:
Pub.L. 112 - 181 712
Name of Law: NDAA FY15
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:
83 FR 47891
09/21/2018
30-day Notice:
Federal Register Citation:
Citation Date:
83 FR 59367
11/23/2018
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
TRICARE: Standard Survey of Civilian Providers
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
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
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
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.
Annual Cost to Federal Government:
$569,570
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
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.
No
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.
No
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:
Kira Starks 571 372-4529 danikquia.k.starks.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:
11/26/2018
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