Continued Health Care Benefit Program (CHCBP) Application

ICR 200905-0704-006

OMB: 0704-0364

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
0704-0364 200905-0704-006
Historical Active 200509-0704-003
DOD/DODDEP
Continued Health Care Benefit Program (CHCBP) Application
Extension without change of a currently approved collection   No
Regular
Approved without change 08/19/2009
Retrieve Notice of Action (NOA) 05/31/2009
  Inventory as of this Action Requested Previously Approved
08/31/2012 36 Months From Approved 08/31/2009
2,500 0 808
625 0 202
0 0 0

The Continued Health Care Benefit Program (CHCBP) is a program of temporary health care coverage that is offered to individuals when they lost military health benefits. To enroll in CHCBP, an individual must first submit a written enrollment application. The DD Form 2837 is used as the information collection vehicle for that enrollment process.

US Code: 10 USC 1078a Name of Law: null
  
None

Not associated with rulemaking

  73 FR 71624 11/25/2008
73 FR 71624 11/25/2008
No

1
IC Title Form No. Form Name
Continued Health Care Benefit Program (CHCBP) Application DD From 2837 Continued Health Care Benefit Program (CHCBP) Application

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,500 808 0 0 1,692 0
Annual Time Burden (Hours) 625 202 0 0 423 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Increase in respondents.

$2,225
No
No
Uncollected
Uncollected
No
Uncollected
Patricia Toppings 703 696-5284 PLToppings@whs.mil

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/31/2009


© 2024 OMB.report | Privacy Policy