(1) The
Authorization Agreement for release of benefit payments should be
revised too improve its readibility. The current version is
complicated to be easily understood. (2) The Privacy Act statement
should be revised to cite the proper legal authoritis for
collecting information and to indicate whethr submission of the
SSAN is mandatory.
Inventory as of this Action
Requested
Previously Approved
04/30/1985
04/30/1985
12,000
0
0
3,000
0
0
0
0
0
THE ENROLLMENT FORM PROVIDES CHAMPUS
INFORMATION NEEDED TO IMPLEMENT AND MANAGE THE DEMONSTRATION
PROJECT MANDATED BY CONGRESS. IT PROVIDE PARTICIPATING PLANS WITH
ALL NECESSARY ENROLLMENT INFORMATION AND PROVIDES DEERS WITH THE
NECESSARY INFORMATION ON ENROLLMENT IN PREPAID PLANS.
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:
(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;
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.