Information Collection

Claim Certification and Voucher for Death Gratuity Payment

IC 186640 under ICR 202105-0730-001 · OMB 0730-0017.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0730-0017 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD Form 397 Claim Certification and Voucher for Death Gratuity Payment	Form
DD Form 397 Claim Certification and Voucher for Death Gratuity Payme dd397_20171027.pdf www.esd.whs.mil/Directives/forms/dd0001_0499/	Form
DD Form 397 Claim Certification and Voucher for Death Gratuity Payme dd397_20171027.pdf www.esd.whs.mil/Directives/forms/dd0001_0499/	Form

IC Title:

Claim Certification and Voucher for Death Gratuity Payment

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 397	Claim Certification and Voucher for Death Gratuity Payment	dd397_20171027.pdf	https://www.esd.whs.mil/Directives/forms/dd0001_0499/	Yes	No	Printable Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title: T7340 Defense Joint Military Pay System-Active Component

FR Citation: 71 FR 14179

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	1,813	1,813

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.