Camp Lejeune Family Member Program Treating Physician Report

RIN 2900-AO79 Reimbursement of Certain Medical Expenses for Camp Lejeune Family Members

OMB: 2900-0822

IC ID: 210896

Information Collection (IC) Details

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Camp Lejeune Family Member Program Treating Physician Report
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 10-10068b Camp Lejeune Family Member Program Treating Physician Report DRAFT-Treating Physician Form-072014.pdf Yes No Fillable Printable

Health Health Care Services

 

1,629 0
   
Individuals or Households
 
   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 1,629 1,629 0 0 0 0
Annual IC Time Burden (Hours) 407 407 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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