Information Collection

Application for Discharge of Member of Survivor of Member of Group Certified to Have Performed Active Duty with the Armed Forces of the United States

IC 5257 under ICR 200108-0704-003 · OMB 0704-0100.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Application for Discharge of Member of Survivor of Member of Group Certified to Have Performed Active Duty with the Armed Forces of the United States	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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
Form	DD-2168				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	1,500	1,500
Annual IC Cost Burden (Dollars)	2,000	2,000

Documents for IC

Title	Document	Date Uploaded

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