e2569 Module

Third Party Collection Program (Insurance Information)

OMB: 0720-0055

IC ID: 255333

Documents and Forms
Document Name
Document Type
Other-Screenshots
Other-Screenshots
Information Collection (IC) Details

View Information Collection (IC)

e2569 Module
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screenshots e2569 Module_2022.pdf Yes Yes Fillable Fileable

Defense and National Security Operational Defense

 

1,546,000 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,319,000 0 2,319,000 0 0 0
Annual IC Time Burden (Hours) 154,600 0 154,600 0 0 0
Annual IC Cost Burden (Dollars) 4,882,268 0 4,882,268 0 0 0

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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