Physician Certificate for Child Annuitant

ICR 202004-0730-004

OMB: 0730-0011

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2020-04-28
Supplementary Document
2017-03-29
Supporting Statement A
2020-05-07
IC Document Collections
IC ID
Document
Title
Status
5643 Unchanged
ICR Details
0730-0011 202004-0730-004
Active 201703-0730-001
DOD/DFAS
Physician Certificate for Child Annuitant
Extension without change of a currently approved collection   No
Regular
Approved without change 06/11/2020
Retrieve Notice of Action (NOA) 05/07/2020
  Inventory as of this Action Requested Previously Approved
06/30/2023 36 Months From Approved 06/30/2020
240 0 240
240 0 240
11,670 0 11,670

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.

US Code: 10 USC 1435 Name of Law: Eligible Beneficiaries
   US Code: 10 USC 1447 Name of Law: Definitions
  
None

Not associated with rulemaking

  85 FR 6536 02/05/2020
85 FR 27212 05/07/2020
No

1
IC Title Form No. Form Name
Physician Certificate for Child Annuitant DD 2828 Physician Certificate for Child Annuitant

  Total Approved 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 240 240 0 0 0 0
Annual Time Burden (Hours) 240 240 0 0 0 0
Annual Cost Burden (Dollars) 11,670 11,670 0 0 0 0
No
No

$531
No
    No
    Yes
No
No
No
No
Courtney Comander 571 372-7065 courtney.c.comander.ctr@mail.mil

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/07/2020


© 2024 OMB.report | Privacy Policy