Reserve Component Survivor Benefit Program Election Certificate

Data for Payment of Retired Personnel

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0569 can be found here:

Documents and Forms

Document Name Document Type
Form DD 2656-5 Reserve Component Survivor Benefit Program Election Certificate Form and Instruction
DD 2656-5 Reserve Component Survivor Benefit Program Election Cert dd2656-5.PDF Form and Instruction
0704-0569_ SSN Justification (DD 2656).pdf SS Justification IC Document

Information Collection (IC) Details

IC Title:	Reserve Component Survivor Benefit Program Election Certificate	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 1320.5(d)(2)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DD 2656-5	Reserve Component Survivor Benefit Program Election Certificate	dd2656-5.PDF		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title: Privacy Act of 1974; System of Records	FR Citation: 74 FR 396

Number of Respondents: 5,900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,900	5,900
Annual IC Time Burden (Hours)	1,475	1,475
Annual IC Cost Burden (Dollars)	38,881	38,881

Documents for IC

Title	Document	Date Uploaded
SS Justification	0704-0569_ SSN Justification (DD 2656).pdf	04/07/2020

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