Information Collection

Continued Health Care Benefit Program (CHCBP) Application

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

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.