View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0704-0364	ICR Reference No: 199404-0704-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: ENROLLMENT APPLICATION, CONTINUED HEALTH CARE BENEFIT PROGRAM (CHCBP)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/12/1994
	Date Received in OIRA: 04/28/1994
Terms of Clearance: This information collection request is approved for one year with the understanding that the form is temporary until a TPA is selected to administer the program and develops a final form. The final form will be submitted for OMB approval.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/1995	05/31/1995
Responses	100,000	0	0
Time Burden (Hours)	25,000	0	0
Cost Burden (Dollars)	0	0	0

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