Information Collection

Marine Corps NAF Group Insurance and Retirement Enrollment Waiver Change Agreement Form

IC 253050 under ICR 202204-0703-003 · OMB 0703-0071.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NAVMC 12000/499 Marine Corps NAF Group Insurance and Retirement Enrollment Waiver Change Agreement Form	Form
Form NAVMC 12000/499 Marine Corps NAF Group Insurance and Retirement Agreement Marine Corps NAF Group Insurance and Retirement Enrollment Waiver Change Agreement Form	Form
NAVMC 12000/499 Marine Corps NAF Group Insurance and Retirement Agreemen NAVMC_XXXX_Review_MC_NAF_Group_Insur_Retir_Agreement(10b).pdf	Form
NAVMC 12000/499 Marine Corps NAF Group Insurance and Retirement Agreemen NAVMC_XXXX_Review_MC_NAF_Group_Insur_Retir_Agreement(10b).pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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
Form	NAVMC 12000/499				Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	253	253

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.

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