TELEPHONE SURVEY OF CHAMPUS BENEFICIARY HOUSEHOLDS

ICR 198905-0704-001

OMB: 0704-0300

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
109098
Migrated
ICR Details
0704-0300 198905-0704-001
Historical Active
DOD/DODDEP
TELEPHONE SURVEY OF CHAMPUS BENEFICIARY HOUSEHOLDS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/25/1989
Retrieve Notice of Action (NOA) 05/26/1989
  Inventory as of this Action Requested Previously Approved
10/31/1990 10/31/1990
900 0 0
360 0 0
0 0 0

OASD(HA) NEEDS DATA TO DETERMINE THE EFFECTS OF THE CONTRACTED PROVIDE ARRANGEMENT (CPA) DEMONSTRATION. THIS DATA WILL BE USED TO ASSESS THE OPERATIONAL EFFECTIVENESS AND EFFICACY OF THIS MENTAL HEALTH DEMONSTRATION. THE PUBLIC CONSISTS OF CHAMPUS BENEFICIARIES.

None
None


No

1
IC Title Form No. Form Name
TELEPHONE SURVEY OF CHAMPUS BENEFICIARY HOUSEHOLDS

  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 900 0 0 900 0 0
Annual Time Burden (Hours) 360 0 0 360 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
05/26/1989


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