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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.