Evidence to Prove Dependency of a Child

Documents and Forms

Information Collection (IC) Details

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IC Title:	Evidence to Prove Dependency of a Child	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 843.401 5 CFR 831.671

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			RI25-037_2018_03_MarkUp.pdf		Yes	No	Printable Only
Instruction			RI25-037_2021_09_Revised.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title: OPM /Central-1	FR Citation: 73 FR 15013

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	250	0	250
Annual IC Time Burden (Hours)	250	0	250
Annual IC Cost Burden (Dollars)	6,718	6,718	0

Documents for IC

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.