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Domestic Abuse Victim Reporting Option Statement
Domestic Abuse Victim Reporting Option Statement
OMB: 0704-0666
IC ID: 259324
OMB.report
DOD/DODDEP
OMB 0704-0666
ICR 202302-0704-008
IC 259324
( )
Documents and Forms
Document Name
Document Type
Form DD Form 2967
Domestic Abuse Victim Reporting Option Statement
Form and Instruction
DD Form 2967 Domestic Abuse Victim Reporting Option Statement
dd2967_20230419.PDF
Form and Instruction
DD Form 2967 Domestic Abuse Victim Reporting Option Statement
dd2967_20230419.PDF
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Domestic Abuse Victim Reporting Option Statement
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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 and Instruction
DD Form 2967
Domestic Abuse Victim Reporting Option Statement
dd2967_20230419.PDF
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Defense and National Security
Subfunction:
Operational Defense
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
20,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
20,000
0
20,000
0
0
0
Annual IC Time Burden (Hours)
25,000
0
25,000
0
0
0
Annual IC Cost Burden (Dollars)
708,800
0
708,800
0
0
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.