View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0720-0055	ICR Reference No: 201606-0720-003
Status: Historical Active	Previous ICR Reference No: 201304-0720-003
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: Third Party Collection Program (Insurance Information)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/05/2016
	Date Received in OIRA: 06/30/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved	08/31/2016
Responses	5,850,000	0	2,936,905
Time Burden (Hours)	390,000	0	146,845
Cost Burden (Dollars)	9,956,700	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	5,850,000	2,936,905	2,913,095
Annual Time Burden (Hours)	390,000	146,845	243,155
Annual Cost Burden (Dollars)	9,956,700	0	9,956,700

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Average burden per response has been increased by 1 minute as adding new question #7 to identify Veterans Affairs (VA) patients will slightly increase the time spent filling out the DD Form 2569.

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