Physician Certificate for Child Annuitant

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0730-0011 can be found here:

Documents and Forms

Document Name Document Type
Form DD Form 2828 Physician Certificate for Child Annuitant Form
DD Form 2828 Physician Certificate for Child Annuitant dd2828.pdf Form
0730-0011 Signed 83-I.pdf 0730-0011 Signed 83-I.pdf IC Document
AUTHORITY LINKS.doc Authority Links IC Document
07b_35.pdf DoD 7000.14-R, Volume 7B, Chapter 35 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Physician Certificate for Child Annuitant	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 Form 2828	Physician Certificate for Child Annuitant	dd2828.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 15 %

	Approved	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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