Information Collection

Retroactive Stop Loss Special Pay

IC 190960 under ICR 200910-0704-002 · OMB 0704-0464.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0464 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD Form x595 Retroactive Stop Loss Special Pay	Form and Instruction
DD Form x595 Claim for Retroactive Stop Loss Payment ddx595.pdf	Form and Instruction
STATEMENT OF DETERMINATION (Emergency).doc Statement of Determination	IC Document

IC Title:

Retroactive Stop Loss Special Pay

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 32 CFR 279

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DD Form x595	Claim for Retroactive Stop Loss Payment	ddx595.pdf		Yes	No	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Strategic National and Theater Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 185,887

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	185,887	185,887
Annual IC Time Burden (Hours)	92,944	92,944
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Statement of Determination	STATEMENT OF DETERMINATION (Emergency).doc	10/13/2009

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