Application for Annuity - Certain Military Surviving Spouses

Forms and Documents

Document	Type	Status	Availability

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Collection	Type	Status	Form
5482	Application for Annuity - Certain Military Surviving Spouses	Form	Migrated

ICR Details

OMB Control No: 0704-0402	ICR Reference No: 200411-0704-004
Status: Historical Active	Previous ICR Reference No: 200110-0704-001
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Application for Annuity - Certain Military Surviving Spouses
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/04/2005
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/24/2004
Terms of Clearance: This information collection is cleared with the understanding that the skip logic for DD Form 2769 will be clarified so that surviving spouses will be more readily able to follow if they are eligible for benefits. The revised form is to be submitted to OMB prior to publication.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2008	03/31/2008	03/31/2005
Responses	75	0	200
Time Burden (Hours)	75	0	200
Cost Burden (Dollars)	0	0	2,000

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Abstract: The Defense Authorization Act of FY 1998, P.L. 105-85, Section 644 (as amended by P.L. 106-65, Section 656) requires the Secretary of Defense to pay an annuity to qualified surviving spouses. The DD Form 2769, Application for Annuity - Certain Military Surviving Spouses, used in this information collection, provides a vehicle for the surviving spouse to apply for the annuity benefit. The Department will use this information to determine if the applicant is eligible for the annuity benefit and make payment to the surviving spouse.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for Annuity - Certain Military Surviving Spouses	DD-2769

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ICR Summary of Burden

	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	75	200	0	0	-125	0
Annual Time Burden (Hours)	75	200	0	0	-125	0
Annual Cost Burden (Dollars)	0	2,000	0	0	-2,000	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/24/2004

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