Information Collection

Defense Sexual Assault Incident Supplementary Reporting

IC 234081 under ICR 202105-0704-001 · OMB 0704-0482.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0482 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD Form 2910-2 Defense Sexual Assault Incident Supplementary Reporting	Form
Form DD Form 2910-2 Retaliation Reporting Statement for Unrestricted Sexual Assault Cases Defense Sexual Assault Incident Supplementary Reporting	Form
Form DD Form 2910-1 Replacement of Lost DD Form 2910 Victim Reporting Preference Statement Defense Sexual Assault Incident Supplementary Reporting	Form
DD Form 2910-2 Retaliation Reporting Statement for Unrestricted Sexual dd2910-2 draft 20211004.pdf	Form
DD Form 2910-2 Retaliation Reporting Statement for Unrestricted Sexual dd2910-2 draft 20211004.pdf	Form
DD Form 2910-1 Replacement of Lost DD Form 2910 Victim Reporting Prefer dd2910-1 Draft 20181114.PDF	Form
DD Form 2910-1 Replacement of Lost DD Form 2910 Victim Reporting Prefer dd2910-1 Draft 20181114.PDF	Form

IC Title:

Defense Sexual Assault Incident Supplementary Reporting

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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 2910-2				Yes	Yes	Fillable Fileable
Form	DD Form 2910-1				Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	53	51	2
Annual IC Time Burden (Hours)	133	128	5
Annual IC Cost Burden (Dollars)	3,486	3,354	132

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.

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