Information Collection

Pilot Test Of Champus Prepaid Health Benefit Demonstration - Surveys

IC 108761 under ICR 198204-0704-005 · OMB 0704-0164.

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Information Collection (IC) Details

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IC Title:	PILOT TEST OF CHAMPUS PREPAID HEALTH BENEFIT DEMONSTRATION - SURVEYS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,600	12,600
Annual IC Time Burden (Hours)	8,429	8,429
Annual IC Cost Burden (Dollars)	0	0

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