Information Collection

Family Needs Assessment

IC 233016 under ICR 202108-0704-006 · OMB 0704-0580.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0580 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD 3054 Family Needs Assessment	Form
DD 3054 Exceptional Family Program (EFMP) Family Needs Assessmen dd3054 20220126.pdf	Form
DD 3054 Exceptional Family Program (EFMP) Family Needs Assessmen dd3054 20220126.pdf	Form

IC Title:

Family Needs Assessment

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 3054	Exceptional Family Program (EFMP) Family Needs Assessment	dd3054 20220126.pdf		No		Paper Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,000

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20,000	0	20,000
Annual IC Time Burden (Hours)	10,000	0	10,000
Annual IC Cost Burden (Dollars)	270,800	-1,000	271,800

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.