Information Collection Request

CLAIMS APPLICATION-(BEARER/INDIVIDUALS)

ICR 198111-1535-015 · OMB 1535-0016 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
127522 CLAIMS APPLICATION-(BEARER/INDIVIDUALS) Form Migrated

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/1982 12/31/1982 12/31/1981
175 0 150
175 0 150
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
CLAIMS APPLICATION-(BEARER/INDIVIDUALS) PD 1022-1

table that charts list 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 175 150 0 25 0 0
Annual Time Burden (Hours) 175 150 0 25 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No