Information Collection

Physician Certificate for Child Annuitant

IC 5643 under ICR 201001-0730-001 · OMB 0730-0011.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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
AUTHORITY LINKS.doc Authority Links	IC Document
07b_35.pdf DoD 7000.14-R, Volume 7B, Chapter 35	IC Document

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:

table that charts list of 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: Defense and National Security

Subfunction: Operational Defense

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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Authority Links	AUTHORITY LINKS.doc	08/30/2006
DoD 7000.14-R, Volume 7B, Chapter 35	07b_35.pdf	08/30/2006

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