Information Collection

Continued Health Care Benefit Program (CHCBP) Application

IC 5414 under ICR 202007-0704-001 · OMB 0704-0364.

Documents and Forms

Document Name Document Type
Form DD Form 2837 Continued Health Care Benefit Program (CHCBP) Application Form
DD Form 2837 Continued Health Care Benefit Program (CHCBP) Applicatio dd2837.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Continued Health Care Benefit Program (CHCBP) Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 32 CFR 199.20

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DD Form 2837	Continued Health Care Benefit Program (CHCBP) Application	dd2837.pdf		Yes	No	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,475	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,475	-1,025	2,500
Annual IC Time Burden (Hours)	369	-256	625
Annual IC Cost Burden (Dollars)	2,670	2,670	0

Documents for IC

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.