DD Form X678 Series

Family Member Travel Screening

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0560 can be found here:

Documents and Forms

Document Name Document Type
Form DD X678-4 TEST DD Form X678 Series Form and Instruction
DD X678 TEST Screening Verification DDX678 TEST.PDF Form and Instruction
DD X678-1 TEST Medical and Educational Information DDX678-1 TEST.PDF Form and Instruction
DD X678-2 TEST Dental Health Information DDX678-2 TEST.PDF Form and Instruction
DD X678-3 TEST Patient Care Review DDX678-3 TEST.PDF Form and Instruction
DD X678-4 TEST Administrative Review Checklist DDX678-4 TEST.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	DD Form X678 Series	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	DD X678-4 TEST	Administrative Review Checklist	DDX678-4 TEST.pdf	No	Paper Only
Form and Instruction	DD X678 TEST	Screening Verification	DDX678 TEST.PDF	No	Paper Only
Form and Instruction	DD X678-1 TEST	Medical and Educational Information	DDX678-1 TEST.PDF	No	Paper Only
Form and Instruction	DD X678-2 TEST	Dental Health Information	DDX678-2 TEST.PDF	No	Paper Only
Form and Instruction	DD X678-3 TEST	Patient Care Review	DDX678-3 TEST.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: 17,943	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17,943	17,943
Annual IC Time Burden (Hours)	4,617	4,617
Annual IC Cost Burden (Dollars)	177,030	177,030

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.