View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0720-0006	ICR Reference No: 199608-0720-001
Status: Historical Active	Previous ICR Reference No: 199304-0720-001
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: CHAMPUS Claim Form, Patient's Request for Medical Payment
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/28/1996
	Date Received in OIRA: 08/29/1996
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/1999	10/31/1999
Responses	1,500,000	0	0
Time Burden (Hours)	375,000	0	0
Cost Burden (Dollars)	0	0	0

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