View Information Collection (IC)

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 Form 2569 Third Party Collection Program/Medical Services Account/Other Health Insurance dd2569 20160616 draft.PDF Yes Yes Fillable Fileable Signable

Defense and National Security Operational Defense

DHA 12 Third Pary Collection System  78 FR 69076

3,900,000 0
Individuals or Households
   20 %

  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 5,850,000 0 2,913,095 0 0 2,936,905
Annual IC Time Burden (Hours) 390,000 0 243,155 0 0 146,845
Annual IC Cost Burden (Dollars) 9,956,700 0 9,956,700 0 0 0

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