Information Collection

Domestic Abuse Victim Reporting Option Statement

IC 259324 under ICR 202302-0704-008 · OMB 0704-0666.

Documents and Forms

Document Name Document Type
Form DD Form 2967 Domestic Abuse Victim Reporting Option Statement Form and Instruction
DD Form 2967 Domestic Abuse Victim Reporting Option Statement dd2967_20230419.PDF Form and Instruction
DD Form 2967 Domestic Abuse Victim Reporting Option Statement dd2967_20230419.PDF Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Domestic Abuse Victim Reporting Option Statement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DD Form 2967	Domestic Abuse Victim Reporting Option Statement	dd2967_20230419.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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	25,000	25,000
Annual IC Cost Burden (Dollars)	708,800	708,800

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.