View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0730-0017	ICR Reference No: 201712-0730-001
Status: Historical Active	Previous ICR Reference No: 200809-0730-001
Agency/Subagency: DOD/DFAS	Agency Tracking No:
Title: Claim Certification and Voucher for Death Gratuity Payment
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/05/2018
	Date Received in OIRA: 12/26/2017
Terms of Clearance: This collection should be reported by DOD in the Information Collection Budget.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved
Responses	500	0	0
Time Burden (Hours)	250	0	0
Cost Burden (Dollars)	1,813	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses	500	-1,916	2,416
Annual Time Burden (Hours)	250	-958	1,208
Annual Cost Burden (Dollars)	1,813	-25,862	27,675

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This is a reinstatement with change to an expired collection. The number of respondents was reduced due to a re-evaluation of gratuity payments paid.

Annual Cost to Federal Government: $4,856

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Ben McAlduff 480 316-1398 benjamin.d.mcalduff.ctr@mail.mil

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