Information Collection

Declaration and Dissolution of Same Sex Domestic Partnership

IC 207136 under ICR 201305-0704-006 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD Form X653 Declaration and Dissolution of Same Sex Domestic Partnership	Form
DD Form X653 Declaration of a Same-Sex Domestic Partneship for DEERS ddx653_DECLARATION FORM.PDF	Form
DD Form X654 Dissolution of a Same_Sex Domestic Partnership for DEERS ddx654_DISSOLUTION FORM.PDF	Form

IC Title:

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 161

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 X653	Declaration of a Same-Sex Domestic Partneship for DEERS Enrollment	ddx653_DECLARATION FORM.PDF		Yes	No	Fillable Printable
Form	DD Form X654	Dissolution of a Same_Sex Domestic Partnership for DEERS Termination	ddx654_DISSOLUTION FORM.PDF		Yes	No	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title: DMDC 02 DoD

FR Citation: 74 FR 39657

Number of Respondents: 8,250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,250	8,250
Annual IC Time Burden (Hours)	276	276
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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