Information Collection

Services/or Supplies Provided By Civilian Hospitals

IC 108629 under ICR 198206-0704-005 · OMB 0704-0087.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0087 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	SERVICES/OR SUPPLIES PROVIDED BY CIVILIAN HOSPITALS	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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DA 1863-1				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 850,000	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	Previously Approved
Annual Number of Responses for this IC	850,000	150,000	700,000
Annual IC Time Burden (Hours)	425,000	75,000	350,000
Annual IC Cost Burden (Dollars)	0	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.