DD-2792 Family Member Medical Summary (Medical Providers)

Exceptional Family Member Program

OMB: 0704-0411

IC ID: 242889

Information Collection (IC) Details

View Information Collection (IC)

DD-2792 Family Member Medical Summary (Medical Providers)
 
No Modified
 
Required to Obtain or Retain Benefits
 

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

Defense and National Security Operational Defense

 

11,166 0
   
Individuals or Households
 
   30 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 11,166 0 0 0 0 11,166
Annual IC Time Burden (Hours) 4,653 0 0 0 0 4,653
Annual IC Cost Burden (Dollars) 502,051 0 33,079 0 0 468,972

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