EVALUATION OF CHAMPUS REFORM (CRI AND CAM DEMONSTRATIONS) BENEFICIARY SURVEY

ICR 199109-0704-002

OMB: 0704-0289

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0704-0289 199109-0704-002
Historical Active 198802-0704-002
DOD/DODDEP
EVALUATION OF CHAMPUS REFORM (CRI AND CAM DEMONSTRATIONS) BENEFICIARY SURVEY
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 11/15/1991
Retrieve Notice of Action (NOA) 09/13/1991
  Inventory as of this Action Requested Previously Approved
11/30/1994 11/30/1994
7,000 0 0
2,100 0 0
0 0 0

THE DEPARTMENT OF DEFENSE DEMONSTRATING A MAJOR REFORM TO CHAMPUS, CALLED THE CHAMPUS REFORM INITIATIVE. EVALUATION OF THE IMPACT OF THE DEMONSTRATION WILL RELY HEAVILY ON DOD DATA SYSTEMS, BUT A BENEFICIARY SURVEY WILL BE REQUIRED TO SUPPLY CRUCIAL MISSING DATA ON ACCESS TO CARE, COSTS, AND BENEFICIA SATISFACTION.

None
None


No

1
IC Title Form No. Form Name
EVALUATION OF CHAMPUS REFORM (CRI AND CAM DEMONSTRATIONS) BENEFICIARY SURVEY

  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 7,000 0 0 7,000 0 0
Annual Time Burden (Hours) 2,100 0 0 2,100 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.
09/13/1991


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