Information Collection

Application for Department of Defense Impact Aid for Children with Severe Disabilities

IC 5521 under ICR 201705-0704-001 · OMB 0704-0425.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0425 can be found here:

Documents and Forms

Document Name Document Type
Form DD Form 816 Application for Department of Defense Impact Aid for Children with Severe Disabilities Form
Sample Award Letter.docx Other-Sample Award Letter
Initial Email Notification to LEAs.docx Other- Initial Email Notification to
DD Form 816 Application for Department of Defense Impact Aid for Chi SD Form 816 - with example.pdf www.dtic.mil/whs/directives/forms/sdforms.htm Form
DD Form 816c Application for Department of Defense Impact Aid for Chi SD Form 816c - with example.pdf www.dtic.mil/whs/directives/forms/sdforms.htm Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Department of Defense Impact Aid for Children with Severe Disabilities	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 816	Application for Department of Defense Impact Aid for Children with Severe Disabilities for School Year 20__ - 20__	SD Form 816 - with example.pdf	http://www.dtic.mil/whs/directives/forms/sdforms.htm	Yes	Yes	Fillable Fileable
Form	DD Form 816c	Application for Department of Defense Impact Aid for Children with Severe Disabilities for School Year 20__ - 20__ (Continuation Sheet)	SD Form 816c - with example.pdf	http://www.dtic.mil/whs/directives/forms/sdforms.htm	Yes	Yes	Fillable Fileable
Other-Sample Award Letter			Sample Award Letter.docx		Yes	No	Printable Only
Other- Initial Email Notification to LEAs			Initial Email Notification to LEAs.docx		Yes	No	Printable Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	14,700	14,700

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.