View Information Collection Request (ICR) Package
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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:
0704-0582
ICR Reference No:
201811-0704-003
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
DOD/DODDEP
Agency Tracking No:
0704-EMLD
Title:
Defense Logistics Agency Child and Youth Program
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:
02/05/2019
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/11/2018
Terms of Clearance:
DOD must report this collection in thier submission to the information collection budget.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2022
36 Months From Approved
Responses
12,055
0
0
Time Burden (Hours)
963
0
0
Cost Burden (Dollars)
21,217
0
0
Abstract:
The Department of Defense (DoD) requires the information in the proposed collection in support of Defense Logistics Agency (DLA) Child and Youth Programs (CYPs). This collection includes fourteen (14) DLA forms, some of which are used by all of the collection respondents and some of which are used under specific circumstances. The information collected is used for program planning, management, and health and safety purposes. More specifically, the information in the proposed collection allows CYP staff to provide safe, developmentally appropriate day care services and to ensure proper, effective response in the event of an emergency. Respondents include patrons enrolling their children in a CYP; these patrons may include active duty military, DoD civilian employees, or DoD contractors.
Authorizing Statute(s):
None
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
83 FR 46485
09/13/2018
30-day Notice:
Federal Register Citation:
Citation Date:
83 FR 59369
11/23/2018
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
12
IC Title
Form No.
Form Name
DLA CYP Health Screening/Assessment (DLA Forms 1855/1855-1)
DLA Form 1855, DLA Form 1855-1
DLA Child and Youth Program (CYP) Health/Developmental Screening
,
DLA Child and Youth Program (CYP) Health Assessment for Enrollment and Renewal
DLA Form 1849
DLA 1849
Child and Youth Program (CYP) Medication Consent and Administration Log
DLA Form 1849-1
DLA Form 1849-1
DLA Child and Youth Program (CYP) Parental Consent for Field Trip
DLA Form 1849-2
DLA Form 1849-2
DLA CYP Insect Repellent Use Consent
DLA Form 1849-3
DLA Form 1849-3
DLA CYP Basic Care Item Consent to Apply
DLA Form 1849-4
DLA Form 1849-4
DLA CYP Child Illness/Injury Readmission Record
DLA Form 1855-1A
DLA Form 1855-1A
DLA Child and Youth Program Respiratory Medical Action Plan
DLA Form 1855-1B
DLA 1855-1B
DLA Child and Youth Program Special Diet Statement
DLA Form 1855-1C
DLA Form 1855-1C
DLA Child and Youth Program Epilepsy/Seizure Medical Action Plan
DLA Form 1855-1D
DLA Form 1855-1D Part 2, DLA Form 1855-1D Part 1
DLA CYP Diabetes Daily Medical Action Plan
,
DLA CYP Diabetes Emergency Medical Action Plan
DLA Form 1855-1E
DLA Form 1855-1E
DLA Child and Youth Program Allergy Medical Action Plan
DLA Form 1855-1F
DLA Form 1855-1F
DLA Child and Youth Program Consent to Perform Caregiving Health Practices and Authorization for Disclosure of Health Information
ICR Summary of Burden
Total Approved
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
12,055
0
0
0
12,055
0
Annual Time Burden (Hours)
963
0
0
0
963
0
Annual Cost Burden (Dollars)
21,217
0
0
0
21,217
0
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:
No
Burden Reduction Due to:
Short Statement:
This is an existing collection currently in use without an OMB Control Number.
Annual Cost to Federal Government:
$10,322
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
Common Form ICR:
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:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(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;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
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.
Certification Date:
12/11/2018
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