Information Collection

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

IC 5649 under ICR 201406-0730-001 · OMB 0730-0014.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0730-0014 can be found here:

Documents and Forms

Document Name Document Type
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
DD Form 137-3 Dependency Statement - Parent dd0137-3.pdf Form
DD Form 137-4 Dependency Statement - Child Born Out Of Wedlock Under A dd0137-4.pdf Form
DD Form 137-5 Dependency Statement - Incapacitated Child Under Age 21 dd0137-5.pdf Form
DD Form 137-6 Dependency Statement - Full Time Student 21-22 Years of dd0137-6.pdf Form
DD Form 137-7 Dependency Statement - Ward of Court dd0137-7.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC 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	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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DD Form 137-3	Dependency Statement - Parent	dd0137-3.pdf	Yes	No	Fillable Printable
Form	DD Form 137-4	Dependency Statement - Child Born Out Of Wedlock Under Age 21	dd0137-4.pdf	Yes	No	Fillable Printable
Form	DD Form 137-5	Dependency Statement - Incapacitated Child Under Age 21	dd0137-5.pdf	Yes	No	Fillable Printable
Form	DD Form 137-6	Dependency Statement - Full Time Student 21-22 Years of Age	dd0137-6.pdf	Yes	No	Fillable Printable
Form	DD Form 137-7	Dependency Statement - Ward of Court	dd0137-7.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: 15,766	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

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

Documents for IC

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.