DLA Form 1855-1C

Defense Logistics Agency Child and Youth Program

Documents and Forms

Document Name Document Type
Form DLA Form 1855-1C DLA Form 1855-1C Form
DLA Form 1855-1C DLA Child and Youth Program Epilepsy/Seizure Medical Act DL1855-1C - OMB Review Final.pdf Form
DLA Form 1855-1C DLA Child and Youth Program Epilepsy/Seizure Medical Act DL1855-1C - OMB Review Final.pdf Form

Information Collection (IC) Details

IC Title:	DLA Form 1855-1C	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DLA Form 1855-1C	DLA Child and Youth Program Epilepsy/Seizure Medical Action Plan	DL1855-1C - OMB Review Final.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: 10	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-10	10
Annual IC Time Burden (Hours)	-1	1
Annual IC Cost Burden (Dollars)	-18	18

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.