Information Collection

DCS 343 and 344: Specific Authorization for Disclosure of Financial Information and Specific Authorization for Release of Behavioral Health and Related Medical Information

IC 275615 under ICR 202506-0705-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DCSA 343 Specific Authorization for Disclosure of Financial Information DCS 343 and 344: Specific Authorization for Disclosure of Financial Information and Specific Authorization for Release of Behavioral Health and Related Medical Information	Form and Instruction
Form DCSA 344 Specific Authorization for Release of Behavioral Health and Related Medical Information DCS 343 and 344: Specific Authorization for Disclosure of Financial Information and Specific Authorization for Release of Behavioral Health and Related Medical Information	Form and Instruction
DCSA 343 Specific Authorization for Disclosure of Financial Infor DCSA 343.docx	Form and Instruction
DCSA 344 Specific Authorization for Release of Behavioral Health DCSA 344.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

DCS 343 and 344: Specific Authorization for Disclosure of Financial Information and Specific Authorization for Release of Behavioral Health and Related Medical Information

Agency IC Tracking Number:

0705

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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 and Instruction	DCSA 343				Yes	Yes	Fillable Fileable
Form and Instruction	DCSA 344				Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,563

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 5 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,563	3,563
Annual IC Time Burden (Hours)	297	297
Annual IC Cost Burden (Dollars)	18,121	18,121

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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