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Continued Health Care Benefit Program (CHCBP) Application
Continued Health Care Benefit Program (CHCBP) Application
OMB: 0704-0364
IC ID: 5414
OMB.report
DOD/DODDEP
OMB 0704-0364
ICR 200509-0704-003
IC 5414
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0364 can be found here:
2020-07-02 - Reinstatement with change of a previously approved collection
2009-05-31 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Continued Health Care Benefit Program (CHCBP) Application
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
DD-2837
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
808
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
808
0
0
0
0
808
Annual IC Time Burden (Hours)
202
0
0
0
0
202
Annual IC Cost Burden (Dollars)
0
0
0
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.