Information Collection Request

Retroactive Stop Loss Special Pay

ICR 200910-0704-002 · OMB 0704-0464 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form DD Form x595 Retroactive Stop Loss Special Pay Form and Instruction New Available
SUPPORTING STATEMENTv2.doc Supporting Statement A Uploaded 2009-10-19 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
190960 Retroactive Stop Loss Special Pay Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
04/30/2010 6 Months From Approved
185,887 0 0
92,944 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Retroactive Stop Loss Special Pay DD Form x595 Claim for Retroactive Stop Loss Payment

table that charts list of burden
  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 185,887 0 185,887 0 0 0
Annual Time Burden (Hours) 92,944 0 92,944 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No