Information Collection

Continued Health Care Benefit Program (CHCBP) Application

IC 5414 under ICR 202608-0720-001 · OMB 0720-0066.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD2837 Continued Health Care Benefit Program Application (CHCBP) Continued Health Care Benefit Program (CHCBP) Application	Form and Instruction
DD2837 Continued Health Care Benefit Program Application (CHCBP dd2837_updated 7.10.2026.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0720-0066

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 32 CFR 199.20

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	DD2837				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: 1,034

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,034	-441	1,475
Annual IC Time Burden (Hours)	259	-110	369
Annual IC Cost Burden (Dollars)	1,874	-796	2,670

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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