DD-2792 Family Member Medical Summary (Family Members)

Exceptional Family Member Program

OMB: 0704-0411

IC ID: 5496

Documents and Forms
Information Collection (IC) Details

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DD-2792 Family Member Medical Summary (Family Members)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction DD Form 2792 Family Member Medical Summary DD Form 2792.pdf Yes Yes Fillable Fileable

Defense and National Security Operational Defense

 

55,828 0
   
Individuals or Households
 
   30 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 55,828 0 11,273 0 44,555 0
Annual IC Time Burden (Hours) 4,652 0 -15,420 0 20,072 0
Annual IC Cost Burden (Dollars) 121,705 0 -527,198 0 648,903 0

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

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