View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0720-0013	ICR Reference No: 201201-0720-001
Status: Historical Active	Previous ICR Reference No: 200811-0720-001
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: 03/27/2012
	Date Received in OIRA: 01/31/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved	03/31/2012
Responses	21,100,000	0	21,100,000
Time Burden (Hours)	525,000	0	525,000
Cost Burden (Dollars)	893,000	0	893,000

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	21,100,000	21,100,000
Annual Time Burden (Hours)	525,000	525,000
Annual Cost Burden (Dollars)	893,000	893,000

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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