Web-based "Health/Benefit Enrollment" (eBenefits)

Exchange Employee Management and Pay System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0702-0139 can be found here:

Documents and Forms

Document Name Document Type
eBenefit Screens.pdf Other-Website

Information Collection (IC) Details

IC Title:	Web-based "Health/Benefit Enrollment" (eBenefits)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Website			eBenefit Screens.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title: AAFES 0903.06 "Personnel Management Information System"	FR Citation: 78 FR 38017

Number of Respondents: 9,960	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	9,960	3,960	6,000
Annual IC Time Burden (Hours)	3,320	1,320	2,000
Annual IC Cost Burden (Dollars)	89,640	39,640	50,000

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.