Information Collection

Champus Choice Enrollment Form

IC 165235 under ICR 198509-0704-009 · OMB 0704-0162.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0162 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	CHAMPUS CHOICE ENROLLMENT FORM	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	CHAMPUS 606				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,590	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	3,590	2,790	800
Annual IC Time Burden (Hours)	538	274	264
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.