Dependency Statements: Parent, Child Born Out of Wedlock, Incapacitated Child Over Age 21, Full Time Student 21-22 Years of Age, and Ward of a Court

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD Form 137-3 Dependency Statements: Parent, Child Born Out of Wedlock, Incapacitated Child Over Age 21, Full Time Student 21-22 Years of Age, and Ward of a Court	Form	Modified	Available
DoDFMR Vol 7A, Ch 26.pdf	Supplementary Document	Uploaded 2014-06-25	Available
T7344.pdf	Supplementary Document	Uploaded 2014-06-25	Available
T7340.pdf	Supplementary Document	Uploaded 2014-06-25	Available
M01040-3.pdf	Supplementary Document	Uploaded 2014-06-25	Available
SSN JUSTIFICATION MEMO 2013 137-4.pdf	Supplementary Document	Uploaded 2014-06-25	Available
SSN JUSTIFICATION MEMO 2013 137-3.pdf	Supplementary Document	Uploaded 2014-06-25	Available
SSN JUSTIFICATION 2013 137-7.pdf	Supplementary Document	Uploaded 2014-06-25	Available
SSN JUSTIFICATION MEMO 2013 137-6.pdf	Supplementary Document	Uploaded 2014-06-25	Available
SSN JUSTIFICATION 2013 137-5.pdf	Supplementary Document	Uploaded 2014-06-25	Available
0730-0014 Supporting Statement - FINAL (revised 7-25-14).docx	Supporting Statement A	Uploaded 2014-07-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
5649	Dependency Statements: Parent, Child Born Out of Wedlock, Incapacitated Child Over Age 21, Full Time Student 21-22 Years of Age, and Ward of a Court	Form	Modified

ICR Details

OMB Control No: 0730-0014	ICR Reference No: 201406-0730-001
Status: Historical Active	Previous ICR Reference No: 200709-0730-001
Agency/Subagency: DOD/DFAS	Agency Tracking No:
Title: Dependency Statements: Parent, Child Born Out of Wedlock, Incapacitated Child Over Age 21, Full Time Student 21-22 Years of Age, and Ward of a Court
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/28/2014
	Date Received in OIRA: 06/26/2014
Terms of Clearance: This collection is approved based on the revised materials provided by the Department. DOD must report this collection as a violation unless they can prove it was not in use before this reinstatement.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved
Responses	20,969	0	0
Time Burden (Hours)	17,474	0	0
Cost Burden (Dollars)	360,667	0	0

---

Abstract: Information is used to certify dependency or obtain information to determine entitlement to basic allowance for housing (BAH) at the dependents rate, travel allowances, or Uniformed Services Identification and Priviledge (USIP) Card. Information regarding a parent, a child born out of wedlock, an incapacitated child over age 21, a full time student 21-22 years of age, or a ward of a court is provided by the military member or by another individual who may be a member of the public.

---

Authorizing Statute(s): US Code: 37 USC 401 Name of Law: null
   US Code: 37 USC 403 Name of Law: null
   US Code: 37 USC 406 Name of Law: null
   US Code: 10 USC 1072 Name of Law: null
   US Code: 10 USC 1076 Name of Law: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 34994	06/11/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 35730	06/24/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Dependency Statements: Parent, Child Born Out of Wedlock, Incapacitated Child Over Age 21, Full Time Student 21-22 Years of Age, and Ward of a Court	DD Form 137-6, DD Form 137-7, DD Form 137-3, DD Form 137-4, DD Form 137-5	Dependency Statement - Parent ,   Dependency Statement - Child Born Out Of Wedlock Under Age 21 ,   Dependency Statement - Incapacitated Child Under Age 21 ,   Dependency Statement - Full Time Student 21-22 Years of Age ,   Dependency Statement - Ward of Court

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	20,969	0	0	0	1,529	19,440
Annual Time Burden (Hours)	17,474	0	0	0	-6,826	24,300
Annual Cost Burden (Dollars)	360,667	0	0	0	-123,632	484,299

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Burden has decreased due to a decrease in eligible dependents. This number fluctuates with member needs.

---

Annual Cost to Federal Government: $373,035

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/26/2014

---