Physician Certificate for Child Annuitant

ICR 200608-0730-001

OMB: 0730-0011

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2006-08-28
IC Document Collections
IC ID
Document
Title
Status
5643 Modified
ICR Details
0730-0011 200608-0730-001
Historical Active 200307-0730-001
DOD/DFAS
Physician Certificate for Child Annuitant
Extension without change of a currently approved collection   No
Regular
Approved without change 10/30/2006
Retrieve Notice of Action (NOA) 08/30/2006
  Inventory as of this Action Requested Previously Approved
10/31/2009 36 Months From Approved 10/31/2006
120 0 120
240 0 240
0 0 0

The DD 2828 is required and must be on file to support an incapacitation occuring prior to age 18. The form provides the authority for the Directorate of Retired and Annuitant Pay, Defense Finance and Accounting Service - Cleveland (DFAS-CL/PD) to establish and pay a Retired Service Member's Family Protection Plan (RSFPP) or Survivor Benefit Plan (SBP) annuity to the incapacitated individual. The form is completed by the child annuitant, and/or their guardian, custodian or legal representative and certified by the physician.

US Code: 10 USC 1401 Name of Law: null
   US Code: 10 USC 1435 Name of Law: null
   US Code: 10 USC 1447 Name of Law: null
   EO: EO 9397 Name/Subject of EO: null
  
None

Not associated with rulemaking

  71 FR 17839 04/07/2006
71 FR 50393 08/25/2006
No

1
IC Title Form No. Form Name
Physician Certificate for Child Annuitant DD Form 2828 Physician Certificate for Child Annuitant

  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 120 120 0 0 0 0
Annual Time Burden (Hours) 240 240 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$281
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Patricia Toppings 703 696-5284 [email protected]

  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.
08/30/2006


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