Information Collection

Application for Department of Defense Impact Aid for Children with Severe Disabilities

IC 5521 under ICR 201103-0704-001 · OMB 0704-0425.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0425 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Secretary of Defen Application for Department of Defense Impact Aid for Children with Severe Disabilities	Form
Guidelines.pdf	Other-Guidelines
Secretary of Defen Application for Department of Defense Impact Aid for Chi sd0816.pdf	Form
Secretary of Defen Application for Department of Defense Impact Aid for Chi sd0816c.pdf	Form
Letter to Superintendent.pdf Letter to Superintendent	IC Document
Guidelines.pdf Guidelines	IC Document
Finance Data.pdf Finance Data	IC Document

IC Title:

Application for Department of Defense Impact Aid for Children with Severe Disabilities

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Secretary of Defense Form 816	Application for Department of Defense Impact Aid for Children with Severe Disabilities	sd0816.pdf	Yes	Yes	Fillable Fileable
Form	Secretary of Defense Form 816-C	Application for Department of Defense Impact Aid for Children with Severe Disabilities (Continuation Page)	sd0816c.pdf	Yes	Yes	Fillable Fileable
Other-Guidelines			Guidelines.pdf	No		Paper Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	50	0	50
Annual IC Time Burden (Hours)	400	0	400
Annual IC Cost Burden (Dollars)	95,900	84,188	11,712

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letter to Superintendent	Letter to Superintendent.pdf	03/10/2011
Guidelines	Guidelines.pdf	03/10/2011
Finance Data	Finance Data.pdf	03/10/2011

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