Information Collection Request
Implementation of the Military Health System Modified Payment and Waiver Program
ICR 202308-0720-001 · OMB 0720-0083 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0720-0083 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 0720-HFSA_SSA_9.27.2024.docx |
Supporting Statement A | Uploaded 2024-09-27 | Available |
| Disapproval Memo script.docx |
Supplementary Document | Uploaded 2024-05-09 | Available |
 SSNJ_DDFormx3201_07.13.2023.pdf |
Supplementary Document | Uploaded 2023-09-13 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 264328 |  Request for Medical Debt Waiver, Military Health System Modified Payment and Waiver Program |
Form and Instruction | New | |
| 262159 | Application for Military Health System Modified Payment and Waiver Program |
Form | New |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOD/DODOASHA |
| OMB Control No | 0720-0083 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Agency Tracking No | 0720-HFSA |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |