Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Request for Medical Debt Discount, Military Health System Modified Payment and Waiver Program Modified 2160 144 4836 Form DD3201
Request for Medical Debt Waiver, Military Health System Modified Payment and Waiver Program Modified 1080 72 2418 Form and Instruction DD3201-1
Total burden requested under this ICR: 3240 216 7254  
To view an IC, click on IC Title