Information Collection

DoD Installation Records Check

IC 236654 under ICR 202309-0704-005 · OMB 0704-0586.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD3058 DoD Installation Records Check	Form
Form DD3058 DoD Installation Records Check DoD Installation Records Check	Form
DD3058 DoD Installation Records Check DD 3058 (2023 update).pdf	Form
DD3058 DoD Installation Records Check DD 3058 (2023 update).pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	DD3058				Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	14,000	0	14,000
Annual IC Time Burden (Hours)	2,333	0	2,333
Annual IC Cost Burden (Dollars)	35,140	18,340	16,800

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.

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