APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION, DEATH PENSION, AND ACCRUED BENEFITS BY A SURVIVING SPOUSE OR CHILD (INCLUDING DEATH COMPENSATION IF APPLICABLE)
ICR 199309-2900-001
OMB: 2900-0004
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2900-0004 can be found here:
APPLICATION FOR DEPENDENCY
AND INDEMNITY COMPENSATION, DEATH PENSION, AND ACCRUED BENEFITS BY
A SURVIVING SPOUSE OR CHILD (INCLUDING DEATH COMPENSATION IF
APPLICABLE)
THIS FORM IS AUTHORIZEE UNDER 38
U.S.C. 1310, 1541, AND 1542 TO GATHER NECESSARY INFORMATION TO
DETERMINE A SPOUSES AND/OR CHILD(REN)'S ELIGIBILITY, DEPENDENCY,
AND INCOME DATA, AS APPLICABLE, FOR THE BENEF SOUGHT.
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.