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Federal forms, ICRs, and supporting documents

Information Collection

TRICARE Competitive Plans Demonstration (CPD) Beneficiary Satisfaction Surveys

IC 277289 under ICR 202505-0704-008 · OMB 0704-0553.

Documents and Forms
Document Name
Document Type
Other-Web Survey
Other-Patient Diary
IC Document
Information Collection (IC) Details

View Information Collection (IC)

TRICARE Competitive Plans Demonstration (CPD) Beneficiary Satisfaction Surveys
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Web Survey CareSource Beneficiary Satisfaction Survey.docx Yes Yes Fillable Fileable
Other-Patient Diary CareSource Beneficiary Qualitiative Patient Diary.docx Yes Yes Fillable Fileable

Defense and National Security Operational Defense

 

35 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 35 0 35 0 0 0
Annual IC Time Burden (Hours) 18 0 18 0 0 0
Annual IC Cost Burden (Dollars) 567 0 567 0 0 0

Title Document Date Uploaded
One Pager Justification 0704-0553_OnePager_CareSource Beneficiary Satisfaction Survey_6.17.2025.docx 08/28/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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