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Information Collection

Request For Health Benefits Under The Champus Program For The Handicapped And The Basic Program

IC 108656 under ICR 198910-0704-001 · OMB 0704-0099.

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Information Collection (IC) Details

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REQUEST FOR HEALTH BENEFITS UNDER THE CHAMPUS PROGRAM FOR THE HANDICAPPED AND THE BASIC PROGRAM
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form (FORMERLY No No
Form 2533 No No
Form 190A) No No
Form CHAMPUS 190 No No
Form DD 2532 No No


    

18,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 18,000 0 0 18,000 0 0
Annual IC Time Burden (Hours) 9,000 0 0 9,000 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
 
 
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.