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: 0704-0559	ICR Reference No: 201807-0704-005
Status: Historical Active	Previous ICR Reference No: 201610-0704-002
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Application for Surrogate Association for DoD Self-Service (DS) Logon
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/11/2018
	Date Received in OIRA: 07/27/2018
Terms of Clearance: The Department must report this collection in the Information Collection Budget.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2021	36 Months From Approved
Responses	5,000	0	0
Time Burden (Hours)	167	0	0
Cost Burden (Dollars)	9,870	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	5,000	5,000
Annual Time Burden (Hours)	167	167
Annual Cost Burden (Dollars)	9,870	9,870

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: There are no changes in burden as this is a new collection. OMB had previously issued a comment on the rule, which generated the OMB Control Number.

Annual Cost to Federal Government: $4,109

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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