Information Collection

Camp Lejeune Family Member Program Information Update Form

IC 210897 under ICR 201403-2900-015 · OMB 2900-0822.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0822 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-10068c Camp Lejeune Family Member Program Information Update Form	Form and Instruction
10-10068c Camp Lejeune Family Member Program Information Update Fo 10-10068c DRAFT CLFM Update Form 508 032614.pdf	Form and Instruction

IC Title:

Camp Lejeune Family Member Program Information Update Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-10068c	Camp Lejeune Family Member Program Information Update Form	10-10068c DRAFT CLFM Update Form 508 032614.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 543

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	543	543
Annual IC Time Burden (Hours)	136	136
Annual IC Cost Burden (Dollars)	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.