Information Collection

CFI 175 ED NCES, CFI 176 DOT FAA ATO, CFI 177 DOD Tricare Outpatient, CFI 178 DOD Tricare Inpatient

IC 186197 under ICR 200707-1505-001 · OMB 1505-0191.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CFI 175 ED NCES questionnaire CFI 175 ED NCES, CFI 176 DOT FAA ATO, CFI 177 DOD Tricare Outpatient, CFI 178 DOD Tricare Inpatient	Form
Form CFI 176 DOT FAA ATO questionnaire CFI 175 ED NCES, CFI 176 DOT FAA ATO, CFI 177 DOD Tricare Outpatient, CFI 178 DOD Tricare Inpatient	Form
Form CFI 177 DOD Tricare Outpatient questionnaire CFI 175 ED NCES, CFI 176 DOT FAA ATO, CFI 177 DOD Tricare Outpatient, CFI 178 DOD Tricare Inpatient	Form
Form CFI 178 DOD Tricare Inpatient CFI 175 ED NCES, CFI 176 DOT FAA ATO, CFI 177 DOD Tricare Outpatient, CFI 178 DOD Tricare Inpatient	Form
CFI 175 ED NCES questionnaire CFI 175 ED NCES.doc	Form
CFI 176 DOT FAA ATO questionnaire CFI 176 DOT FAA ATO.doc	Form
CFI 177 DOD Tricare Outpatient questionnaire CFI 177 DOD Tricare Outpatient.doc	Form
CFI 178 DOD Tricare Inpatient CFI 178 DOD Tricare Inpatient.doc	Form

IC Title:

Agency IC Tracking Number:

CFI 175, CFI 176, CFI 177, CFI 178

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CFI 175	ED NCES questionnaire	CFI 175 ED NCES.doc	Yes	Yes	Fillable Fileable
Form	CFI 176	DOT FAA ATO questionnaire	CFI 176 DOT FAA ATO.doc	Yes	Yes	Fillable Fileable
Form	CFI 177	DOD Tricare Outpatient questionnaire	CFI 177 DOD Tricare Outpatient.doc	No		Paper Only
Form	CFI 178	DOD Tricare Inpatient	CFI 178 DOD Tricare Inpatient.doc	No		Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,040

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	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	1,040	0	0	0	0	0
Annual IC Time Burden (Hours)	208	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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