DLA Form 1855-1F

Defense Logistics Agency Child and Youth Program

OMB: 0704-0582

IC ID: 234117

Information Collection (IC) Details

View Information Collection (IC)

DLA Form 1855-1F
 
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 DLA Form 1855-1F DLA Child and Youth Program Consent to Perform Caregiving Health Practices and Authorization for Disclosure of Health Information DL1855-1F- OMB Review Final.pdf Yes Yes Fillable Fileable Signable

Defense and National Security Operational Defense

 

75 0
   
Individuals or Households
 
   95 %

  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 75 0 0 75 0 0
Annual IC Time Burden (Hours) 6 0 0 6 0 0
Annual IC Cost Burden (Dollars) 132 0 0 132 0 0

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