DLA Form 1849-4

Defense Logistics Agency Child and Youth Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0582 can be found here:

Documents and Forms

Document Name Document Type
Form DLA Form 1849-4 DLA Form 1849-4 Form
DLA Form 1849-4 DLA CYP Child Illness/Injury Readmission Record DL1849-4 - OMB Review Final.pdf Form

Information Collection (IC) Details

IC Title:	DLA Form 1849-4	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DLA Form 1849-4	DLA CYP Child Illness/Injury Readmission Record	DL1849-4 - OMB Review Final.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 828	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	828	828
Annual IC Time Burden (Hours)	66	66
Annual IC Cost Burden (Dollars)	1,457	1,457

Documents for IC

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.