Information Collection

Application for Discharge of Member or Survivor of Group Certified to Have Performed Active Duty with the Armed Forces of the United States

IC 5258 under ICR 202007-0704-005 · OMB 0704-0100.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0100 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD Form 2168 Application for Discharge of Member or Survivor of Group Certified to Have Performed Active Duty with the Armed Forces of the United States	Form
DD Form 2168 Application for Discharge of Member or Survivor of Membe dd2168.PDF	Form

IC Title:

Application for Discharge of Member or Survivor of Group Certified to Have Performed Active Duty with the Armed Forces of the United States

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	DD Form 2168	Application for Discharge of Member or Survivor of Member of Group Certified to have Performed Active Duty with the Armed Forces of the Untied States	dd2168.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: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	500	-2,200	2,700
Annual IC Time Burden (Hours)	250	-1,100	1,350
Annual IC Cost Burden (Dollars)	1,815	-86,756	88,571

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.