Continued Health Care Benefit Program (CHCBP) Application

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0364 can be found here:

Documents and Forms

Document Name Document Type
Form DD From 2837 Continued Health Care Benefit Program (CHCBP) Application Form
DD From 2837 Continued Health Care Benefit Program (CHCBP) Applicatio dd2837.pdf Form

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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 32 CFR 199.20

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DD From 2837	Continued Health Care Benefit Program (CHCBP) Application	dd2837.pdf		Yes	No	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,500	1,692	808
Annual IC Time Burden (Hours)	625	423	202
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.