Information Collection

Sd 816/816c

IC 5521 under ICR 202001-0704-001 · OMB 0704-0425.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0425 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SD 816 SD 816/816C	Form
SD 816 Application for Department of Defense Impact Aid for Chi 0704-0425_sd-0816-20190821.PDF	Form
SD 816c Application for Department of Defense Impact Aid for Chi 0704-0425_SD816C draft 20200214.PDF	Form

IC Title:

SD 816/816C

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	SD 816	Application for Department of Defense Impact Aid for Children with Severe Disabilities	0704-0425_sd-0816-20190821.PDF		Yes	Yes	Fillable Fileable Signable
Form	SD 816c	Application for Department of Defense Impact Aid for Children with Severe Disabilities (continuation page)	0704-0425_SD816C draft 20200214.PDF		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	50	0	50
Annual IC Time Burden (Hours)	400	0	400
Annual IC Cost Burden (Dollars)	14,650	-50	14,700

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.