DEPENDENCY AFFIDAVITS

ICR 198509-0704-012

OMB: 0704-0185

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
165243 Migrated
ICR Details
0704-0185 198509-0704-012
Historical Active 198304-0704-001
DOD/DODDEP
DEPENDENCY AFFIDAVITS
No material or nonsubstantive change to a currently approved collection   No
Emergency 09/30/1985
Approved with change 09/30/1985
Retrieve Notice of Action (NOA) 09/30/1985
  Inventory as of this Action Requested Previously Approved
06/30/1986 06/30/1986 06/30/1986
8,000 0 12,600
12,000 0 18,900
0 0 0

IN COMPLIANCE WITH DEPENDENCE ACT OF 1950, FINANCIAL INFORMATION IS NEEDED TO SCREEN APPLICANTS FOR DEPENDENT ASSISTANCE. IF THE APPLICAN MEETS THE REQUIREMENT OF THE ACT, ASSISTANCE IS PROVIDED.

None
None


No

1
IC Title Form No. Form Name
DEPENDENCY AFFIDAVITS DD-137-3

  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 8,000 12,600 0 -4,600 0 0
Annual Time Burden (Hours) 12,000 18,900 0 -6,900 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
09/30/1985


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