Information Collection

Exceptional Family Member Program

IC 5496 under ICR 200608-0704-007 · OMB 0704-0411.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0411 can be found here:

Documents and Forms

Document Name Document Type
Form DD-2792 Exceptional Family Member Program Form
DD-2792 Exceptional Family Member Medical History dd2792.pdf Form
DD-2792-1 Exceptional Family Member Special Education/Early Interv dd2792-1.pdf Form
0704-0411 Signed 83-I.pdf 0704-0411 Signed 83-I.pdf IC Document
AUTHORITY LINKS.doc Authority Links IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Exceptional Family Member Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-2792	Exceptional Family Member Medical History	dd2792.pdf		Yes	No	Fillable Printable
Form	DD-2792-1	Exceptional Family Member Special Education/Early Intervention Summary	dd2792-1.pdf		Yes	No	Fillable Printable

Line of Business: Education

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 43,332	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 30 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	43,332	26,032	17,300
Annual IC Time Burden (Hours)	19,460	11,675	7,785
Annual IC Cost Burden (Dollars)	672,512	672,512	0

Documents for IC

Title	Document	Date Uploaded
0704-0411 Signed 83-I.pdf	0704-0411 Signed 83-I.pdf	08/30/2006
Authority Links	AUTHORITY LINKS.doc	08/30/2006

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