Application for Discharge of Member or Survivor of Group Certified to Have Performed Active Duty with the Armed Forces of the United States

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD Form 2168 Application for Discharge of Member or Survivor of Member of Group Certified to have Performed Active Duty with the Armed Forces of the Untied States	Form	Modified	Available
Army IPSS-A PIA_Sec1.pdf	Supplementary Document	Uploaded 2026-09-16	Available
0704-0100_DD2168_SSN Memo	Supplementary Document	Uploaded 2020-08-26	Available
0704-0100_SSA_9.21.26 OIM.docx	Supporting Statement A	Uploaded 2026-09-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
5258	Application for Discharge of Member or Survivor of Group Certified to Have Performed Active Duty with the Armed Forces of the United States	Form	Modified	Application for Discharge of Member or Survivor of Member of Group Certified to have Performed Active Duty with the Armed Forces of the Untied States

ICR Details

OMB Control No: 0704-0100	ICR Reference No: 202607-0704-002
Status: Received in OIRA	Previous ICR Reference No: 202308-0704-002
Agency/Subagency: DOW/DODDEP	Agency Tracking No:
Title: Application for Discharge of Member or Survivor of Group Certified to Have Performed Active Duty with the Armed Forces of the United States
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/22/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2026
Responses	500	500
Time Burden (Hours)	250	250
Cost Burden (Dollars)	1,815	1,815

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Abstract: 38 USC 106 note(PL 95-202, Sec 401) directs Secretary of Defense to determine if civilian employment or contractual service rendered by groups to the Armed Forces of the United States shall be considered active duty. Using DD Form 2168, information that is compatible with that of a corresponding approved group and the applicant can provide supporting evidence to receive veteran’s status in accordance with the provisions of DoD Directive 1000.20, as established by 38 U.S.C.§ 106. This information collection is necessary to assist each of the Military Departments in determining if an applicant was a member of a group which has been found to have performed active military service and to assist in issuing an appropriate certificate of service.

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Authorizing Statute(s): US Code: 38 USC 106 note
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 29469	05/20/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 56434	09/02/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Application for Discharge of Member or Survivor of Group Certified to Have Performed Active Duty with the Armed Forces of the United States	DD Form 2168	Application for Discharge of Member or Survivor of Member of Group Certified to have Performed Active Duty with the Armed Forces of the Untied States

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	500	500	0	0	0	0
Annual Time Burden (Hours)	250	250	0	0	0	0
Annual Cost Burden (Dollars)	1,815	1,815	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $8,760

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/22/2026

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