Information Collection

DD-2792 Family Member Medical Summary (Medical Providers)

IC 242889 under ICR 202308-0704-004 · OMB 0704-0411.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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 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 %

table that charts list of burden
	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

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.