Information Collection

Program Information--institutional Providers

IC 165200 under ICR 197810-0704-008 · OMB 0704-0092.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0092 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	PROGRAM INFORMATION--INSTITUTIONAL PROVIDERS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	CHAMPUS	No	No
Form	200,A,B,	No	No
Form	C, & D	No	No
Form	CHAMPUS 200A	No	No
Form	CHAMPUS 200C	No	No
Form	CHAMPUS 200E	No	No
Form	CHAMPUS 200B	No	No
Form	CHAMPUS 200D	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,500	2,500
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.