Information Collection

Exceptional Family Member Program

IC 5496 under ICR 201101-0704-002 · OMB 0704-0411.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0411 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD-2792 Exceptional Family Member Program	Form
DD-2792 Exceptional Family Member Medical History dd2792.pdf	Form
DD-2792-1 Exceptional Family Member Special Education/Early Interv dd2792-1.pdf	Form
AUTHORITY LINKS.doc Authority Links	IC Document

IC Title:

Exceptional Family Member Program

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-2792	Exceptional Family Member Medical History	dd2792.pdf		Yes	No	Fillable Printable
Form	DD-2792-1	Exceptional Family Member Special Education/Early Intervention Summary	dd2792-1.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: 43,332

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 30 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	43,332	0	43,332
Annual IC Time Burden (Hours)	19,460	0	19,460
Annual IC Cost Burden (Dollars)	672,513	1	672,512

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Authority Links	AUTHORITY LINKS.doc	08/30/2006

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