Camp Lejeune Family Member Program Information Update Form

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

OMB: 2900-0822

IC ID: 210897

Information Collection (IC) Details

View Information Collection (IC)

Camp Lejeune Family Member Program Information Update Form
 
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 10-10068c Camp Lejeune Family Member Program Information Update Form 10-10068c DRAFT CLFM Update Form 508 032614.pdf Yes No Fillable Printable

Health Health Care Services

 

543 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 543 543 0 0 0 0
Annual IC Time Burden (Hours) 136 136 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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