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: 0720-0066	ICR Reference No: 202008-0720-001
Status: Historical Active	Previous ICR Reference No: 200905-0704-006
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: Continued Health Care Benefit Program (CHCBP) Application
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/06/2020
	Date Received in OIRA: 08/06/2020
Terms of Clearance: DOD must report this collection in its Information Collection Budget submission.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2023	36 Months From Approved
Responses	1,475	0	0
Time Burden (Hours)	369	0	0
Cost Burden (Dollars)	2,670	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,475	-1,025	2,500
Annual Time Burden (Hours)	369	-256	625
Annual Cost Burden (Dollars)	2,670	2,670	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Revised estimate of the number of respondents.

Annual Cost to Federal Government: $8,503

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Kira Starks 571 372-4529 danikquia.k.starks.ctr@mail.mil

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