DD-2792 Family Member Medical Summary (Medical Providers)

Exceptional Family Member Program

Documents and Forms

Document Name Document Type
Form DD Form 2792 DD-2792 Family Member Medical Summary (Medical Providers) Form and Instruction
DD Form 2792 Family Member Medical Summary (Medical Providers) dd2792 Unlocked - OMB update 20230502.pdf Form and Instruction
DD Form 2792 Family Member Medical Summary (Medical Providers) dd2792 Unlocked - OMB update 20230502.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	DD-2792 Family Member Medical Summary (Medical Providers)	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DD Form 2792	Family Member Medical Summary (Medical Providers)	dd2792 Unlocked - OMB update 20230502.pdf		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: 11,166	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 30 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	11,166	0	11,166
Annual IC Time Burden (Hours)	4,653	0	4,653
Annual IC Cost Burden (Dollars)	502,051	33,079	468,972

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.