Information Collection

Survey of Healthcare Needs of Beneficiaries Age 65+

IC 277311 under ICR 202505-0704-008 · OMB 0704-0553.

Documents and Forms

Document Name Document Type
Survey of Healthcare Needs of Beneficiaries Age 65.docx Other-Web Survey
One Pager Justification.docx Survey of Healthcare Needs of Beneficiaries Age 65+ IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey of Healthcare Needs of Beneficiaries Age 65+	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Web Survey			Survey of Healthcare Needs of Beneficiaries Age 65.docx		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,000	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
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	5,438	5,438

Documents for IC

Title	Document	Date Uploaded
Survey of Healthcare Needs of Beneficiaries Age 65+	One Pager Justification.docx	08/28/2025

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

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