Information Collection

Exceptional Family Member Program(EFMP) Pilot Program Evaluation at Travis Air Force Base Survey

IC 264609 under ICR 202401-0720-002 · OMB 0720-0075.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
MAX Survey - Exceptional Family Member Program (EFMP) Pilot Program Evaluation at Travis Air Force Base Survey.pdf	Other-Survey
EFMP Pilot Program Evaluation at Travis Air Force Base Survey_4.3.2024.pdf	Other-Survey

IC Title:

Agency IC Tracking Number:

0720-EFMP

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
Other-Survey			EFMP Pilot Program Evaluation at Travis Air Force Base Survey_4.3.2024.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 240

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	1,826	1,826

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.