View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0720-0013	ICR Reference No: 200506-0720-001
Status: Historical Active	Previous ICR Reference No: 200201-0720-002
Agency/Subagency: DOW/DODOASHA	Agency Tracking No:
Title: Health Insurance Claim Form, HCFA 1450
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: 08/26/2005
	Date Received in OIRA: 06/14/2005
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2008	08/31/2008	08/31/2005
Responses	21,100,000	0	2,100,000
Time Burden (Hours)	525,000	0	525,000
Cost Burden (Dollars)	893,000	0	859,000

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	21,100,000	2,100,000	19,000,000
Annual Time Burden (Hours)	525,000	525,000	0
Annual Cost Burden (Dollars)	893,000	859,000	34,000

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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