DIAGNOSTIC EVALUATION, PROGRAM FOR THE HANDICAPPED

ICR 198904-0704-026

OMB: 0704-0098

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
165204 Migrated
ICR Details
0704-0098 198904-0704-026
Historical Active 198904-0704-012
DOD/DODDEP
DIAGNOSTIC EVALUATION, PROGRAM FOR THE HANDICAPPED
No material or nonsubstantive change to a currently approved collection   No
Emergency 04/18/1989
Approved with change 04/18/1989
Retrieve Notice of Action (NOA) 04/18/1989
  Inventory as of this Action Requested Previously Approved
09/30/1989 09/30/1989 09/30/1989
840 0 840
840 0 840
0 0 0

THE DIAGNOSTIC EVALUATION, PROGRAM FOR THE HANDICAPPED FORM IS USED TO PROVIDED MEDICAL INFORMATION FOR PERIODIC REVIEW OF BENEFITS PROVIDED TO PHYSICALLY HANDICAPPED OR MENTALLY RETARDED OCHAMPUS BENEFICIARIES. THE FORM IS USED TO DETERMINE WHETHER SERVICES/SUPPLIES PROVIDED UNDER THE PROGRAM FOR THE HANDICAPPED ARE COST-EFFECTIVE AND EFFICIENT.

None
None


No

1
IC Title Form No. Form Name
DIAGNOSTIC EVALUATION, PROGRAM FOR THE HANDICAPPED CHAMPUS, 141

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 840 840 0 0 0 0
Annual Time Burden (Hours) 840 840 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/18/1989


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