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Federal forms, ICRs, and supporting documents

OMB control number

Physician Certificate for Child Annuitant

OMB 0730-0011 ยท DOD/DFAS.

OMB 0730-0011

DD Form 2828 is required and must be on file to support an incapacitation occurring prior to age 18. The form provides the authority for the Directorate of Retired and Annuitant Pay, Defense Finance and Accounting Service - Cleveland (DFAS-CL/PD) to establish and pay a Retired Service Member's Family Protection Plan (RSFPP) or Survivor Benefit Plan (SBP) annuity to the incapacitated individual. The form is completed by the child annuitant, and/or their guardian, custodian or legal representative and certified by the physician.

The latest form for Physician Certificate for Child Annuitant expires 2026-09-30 and is listed under ICR 202306-0730-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
SSN Justification DD2828_20230523.pdf Supplementary Document
0730-0011_SSA_6.30.23.docxSupporting Statement A
Physician Certificate for Child Annuitant Other-Request form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202306-0730-003 Extension without change of a currently approved collection 2023-06-30 Approved without change
202004-0730-004 Extension without change of a currently approved collection 2020-05-07 Approved without change
201703-0730-001 Reinstatement with change of a previously approved collection 2017-04-03 Approved without change
201306-0730-001 Extension without change of a currently approved collection 2013-06-26 Approved without change
201001-0730-001 Extension without change of a currently approved collection 2010-01-31 Approved with change
200608-0730-001 Extension without change of a currently approved collection 2006-08-30 Approved without change
200307-0730-001 Revision of a currently approved collection 2003-07-31 Approved without change
200007-0730-001 New collection (Request for a new OMB Control Number) 2000-07-13 Approved without change