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Information Collection

Request for Medical Debt Discount, Military Health System Modified Payment and Waiver Program

IC 262159 under ICR 202508-0720-002 · OMB 0720-0083.

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Document Name
Document Type
Form
Form
Form
Form
Information Collection (IC) Details

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Request for Medical Debt Discount, Military Health System Modified Payment and Waiver Program
 
No Modified
 
Required to Obtain or Retain Benefits
 
32 CFR 220

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form DD3201 Request for Medical Debt Discount, Military Health System Modified Payment and Waiver Program DD3201 DRAFT 20260130.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

2,160 0
   
Individuals or Households
 
   95 %

  Approved 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 2,160 0 2,160 0 0 0
Annual IC Time Burden (Hours) 144 0 144 0 0 0
Annual IC Cost Burden (Dollars) 4,836 0 4,836 0 0 0

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