Third Party Collection Program (Insurance Information)

Third Party Collection Program (Insurance Information)

OMB: 0704-0323

IC ID: 5378

Information Collection (IC) Details

View Information Collection (IC)

Third Party Collection Program (Insurance Information)
 
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 DD-2569 Third Party Collection Program/Medical Services Account/Other Health Insurance dd2569.pdf Yes Yes Fillable Fileable

Defense and National Security Operational Defense

 

3,507,390 0
   
Individuals or Households
 
   80 %

  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 3,507,390 0 0 700,178 0 2,807,212
Annual IC Time Burden (Hours) 175,370 0 0 35,009 0 140,361
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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