TREATMENT PLAN R.T.C.

ICR 198306-0704-001

OMB: 0704-0096

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
108647 Migrated
ICR Details
0704-0096 198306-0704-001
Historical Active 197809-0704-003
DOD/DODDEP
TREATMENT PLAN R.T.C.
Revision of a currently approved collection   No
Regular
Approved without change 07/29/1983
Retrieve Notice of Action (NOA) 06/08/1983
  Inventory as of this Action Requested Previously Approved
07/31/1986 07/31/1986 07/31/1983
4,500 0 1,500
2,625 0 3,000
0 0 0

THIS SOLICITATION IS NECESSARY TO PROVIDE MEDICAL INFORMATION REQUIRED IN THE PRE-AUTHORIZATION EVALUATION PROCESS OF CHAMPUS BENEFICIARIES REQUESTING SERVICES AND TREATMENT FROM PHSYCHIATRIC RESIDENTIAL TREATMENT CENTERS FOR CHILDREN AND ADOLESCENTS.

None
None


No

1
IC Title Form No. Form Name
TREATMENT PLAN R.T.C. CHAMPUS, 345A

  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 4,500 1,500 0 0 3,000 0
Annual Time Burden (Hours) 2,625 3,000 0 0 -375 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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.
06/08/1983


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