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: 0720-0006	ICR Reference No: 200606-0720-001
Status: Historical Active	Previous ICR Reference No: 200301-0720-001
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: TRICARE DoD/CHAMPUS Medical Claim Patient's Request for Medical Payment
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: 08/04/2006
	Date Received in OIRA: 06/26/2006
Terms of Clearance: Approved consistent with the following terms of clearance: in the next submission of this collection of information to OMB for review, DoD shall report on the feasibility of providing respondents with a fully electronic process for completing and submitting associated forms.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2009	36 Months From Approved	08/31/2006
Responses	2,400,000	0	1,035,000
Time Burden (Hours)	600,000	0	258,750
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	2,400,000	1,035,000	1,365,000
Annual Time Burden (Hours)	600,000	258,750	341,250
Annual Cost Burden (Dollars)	0	0	0

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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