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: 2900-0219	ICR Reference No: 200402-2900-001
Status: Historical Active	Previous ICR Reference No: 200107-2900-018
Agency/Subagency: VA	Agency Tracking No:
Title: CHAMPVA Benefits - Application, Claim, Other Health Insurance & Potential Liability
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/23/2004
	Date Received in OIRA: 02/20/2004
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2007	03/31/2007	03/31/2004
Responses	2,375,500	0	381,000
Time Burden (Hours)	394,667	0	63,000
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	2,375,500	381,000	1,994,500
Annual Time Burden (Hours)	394,667	63,000	331,667
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.