Information Collection

Exceptional Family Member Program

IC 5496 under ICR 201406-0704-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Form 2792 Exceptional Family Member Program	Form and Instruction
DD Form 2792 Family Member Medical Summary DD Form 2792.pdf	Form and Instruction
DD Form 2792-I Special Education/Early Intervention Summary DD Form 2792-1.pdf	Form and Instruction

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 and Instruction	DD Form 2792	Family Member Medical Summary	DD Form 2792.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	DD Form 2792-I	Special Education/Early Intervention Summary	DD Form 2792-1.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 44,555

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	44,555	1,223	43,332
Annual IC Time Burden (Hours)	20,072	612	19,460
Annual IC Cost Burden (Dollars)	648,903	-23,610	672,513

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.