Information Collection

Case Management Intake

IC 212081 under ICR 201406-0704-005 · OMB 0704-0528.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0528 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Military_OneSource_CMS_Screenshots1 (3).pdf	Other-System Screenshots
FactSheet_MOSInfoPaper_15Oct2012_FINAL[1].pdf	Other-Promo Material - Fact Sheet
Military OneSource Overview.pdf	Other-Promo Material - Overview
MOS_CounselingBrochure_26April2013_MT[1].pdf	Other-Promo Material - Brochure
MOS_Flier_General What Can MOS Do For You.pdf	Other-Promo Material - Flier
PAS & ADN (8-4-14).docx	Other-PAS & ADN

IC Title:

Case Management Intake

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-PAS & ADN	PAS & ADN (8-4-14).docx	Yes	Yes	Fillable Fileable
Other-System Screenshots	Military_OneSource_CMS_Screenshots1 (3).pdf	Yes	Yes	Fillable Fileable
Other-Promo Material - Fact Sheet	FactSheet_MOSInfoPaper_15Oct2012_FINAL[1].pdf	Yes	No	Printable Only
Other-Promo Material - Overview	Military OneSource Overview.pdf	Yes	No	Printable Only
Other-Promo Material - Brochure	MOS_CounselingBrochure_26April2013_MT[1].pdf	Yes	No	Printable Only
Other-Promo Material - Flier	MOS_Flier_General What Can MOS Do For You.pdf	Yes	No	Printable Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 900,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	900,000	900,000
Annual IC Time Burden (Hours)	45,000	45,000
Annual IC Cost Burden (Dollars)	759,150	759,150

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.