Information Collection

Case Management Intake

IC 212081 under ICR 201811-0704-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
PAS & ADN (11-16-2018).docx	Other-PAS/ADN
Military_OneSource_CMS_Call_Center_User_Guide.pdf	Other-System User Guide

IC Title:

Case Management Intake

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-PAS/ADN			PAS & ADN (11-16-2018).docx		Yes	Yes	Fillable Fileable
Other-System User Guide			Military_OneSource_CMS_Call_Center_User_Guide.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 225,584

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 Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	225,584	-674,416	900,000
Annual IC Time Burden (Hours)	56,396	11,396	45,000
Annual IC Cost Burden (Dollars)	408,307	-350,843	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.