Information Collection

Identification and Privilege Card Application

IC 219006 under ICR 201511-0702-001 · OMB 0702-0129.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0702-0129 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Exchange Form 1100 Identification and Privilege Card Application	Form and Instruction
DD Form 2574 Dependent Card DD FORM 2574(Portrait View).pdf	Form
Exchange Form 1100 Army & Air Force Exchange Service Identification & Privi Form 1100-016 ADN Draft.pdf	Form and Instruction
Sample ADN PA and Instructions.docx Sample Agency Disclosure Notice, Privacy Act Statement, and Instructions	IC Document

IC Title:

Identification and Privilege Card Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	Exchange Form 1100-016	Army & Air Force Exchange Service Identification & Privilege Card Application	Form 1100-016 ADN Draft.pdf		No		Paper Only
Form	DD Form 2574	Dependent Card	DD FORM 2574(Portrait View).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: 2,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,500	2,500
Annual IC Time Burden (Hours)	625	625
Annual IC Cost Burden (Dollars)	4,525	4,525

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Sample Agency Disclosure Notice, Privacy Act Statement, and Instructions	Sample ADN PA and Instructions.docx	11/18/2015

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