View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0704-0559	ICR Reference No: 202106-0704-013
Status: Historical Active	Previous ICR Reference No: 201807-0704-005
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Application for Surrogate Association for DoD Self-Service (DS) Logon
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/03/2021
	Date Received in OIRA: 09/28/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2024	36 Months From Approved	11/30/2021
Responses	5,000	0	5,000
Time Burden (Hours)	500	0	167
Cost Burden (Dollars)	13,600	0	9,870

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	5,000	5,000	0
Annual Time Burden (Hours)	500	167	333
Annual Cost Burden (Dollars)	13,600	9,870	3,730

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: Burden increased due to an increase in respondent's response time.

Annual Cost to Federal Government: $3,863

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? No

Agency Contact: LaTarsha Yeargins 571 372-2089 latarsha.r.yeargins.ctr@mail.mil

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