Claim Certification and Voucher for Death Gratuity Payment

ICR 202105-0730-001

OMB: 0730-0017

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2021-05-27
Supplementary Document
2017-12-26
Supplementary Document
2017-12-26
IC Document Collections
ICR Details
0730-0017 202105-0730-001
Received in OIRA 201712-0730-001
DOD/DFAS
Claim Certification and Voucher for Death Gratuity Payment
Revision of a currently approved collection   No
Regular 05/27/2021
  Requested Previously Approved
36 Months From Approved 05/31/2021
500 500
250 250
1,813 1,813

This form is used to document and approve death gratuity payments. The Service Casualty Office completes part of the form and provides the form to the Service Member's beneficiaries to complete and sign their portion of the form. The form is sent to DFAS for payment.

US Code: 10 USC 1475 - 1480
  
None

Not associated with rulemaking

  86 FR 531 01/06/2021
86 FR 26707 05/17/2021
No

1
IC Title Form No. Form Name
Claim Certification and Voucher for Death Gratuity Payment DD Form 397 Claim Certification and Voucher for Death Gratuity Payment

  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) 1,813 1,813 0 0 0 0
No
No

$5,807
No
    Yes
    Yes
No
No
No
No
Kellen Stout 317 645-3128 kellen.a.stout.civ@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.
05/27/2021


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