Information Collection

Survey of Healthcare Needs of Beneficiaries Age 65+

IC 277311 under ICR 202505-0704-008 · OMB 0704-0553.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey of Healthcare Needs of Beneficiaries Age 65.docx	Other-Web Survey
One Pager Justification.docx Survey of Healthcare Needs of Beneficiaries Age 65+	IC Document

IC Title:

Agency IC Tracking Number:

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-Web Survey					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: 15,000

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	15,000	15,000
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	5,438	5,438

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey of Healthcare Needs of Beneficiaries Age 65+		08/28/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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