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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0100 can be found here:

Documents and Forms

Document Name Document Type
Form DD Form 2168 Application for Discharge of Member or Survivor of Group Certified to Have Performed Active Duty with the Armed Forces of the United States Form
DD Form 2168 Application for Discharge of Member or Survivor of Membe dd2168.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

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

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
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	dd2168.pdf		Yes	No	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,700	-300	3,000
Annual IC Time Burden (Hours)	1,350	-150	1,500
Annual IC Cost Burden (Dollars)	88,571	88,571	0

Documents for IC

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.