View Information Collection (IC)

View Information Collection (IC)

IC Title:	TRICARE Young Adult Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 32 CFR 199

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ddx605	TRICARE YOUNG ADULT APPLICATION	ddx605.pdf		Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	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	32,000	32,000	0	0	0	0
Annual IC Time Burden (Hours)	8,000	8,000	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSN Justification	A - MFR SSN Justification-TRICARE Young Adult.pdf	03/22/2011
Statement of Determination	Statement of Determination.doc	03/22/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.