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: 0720-0068	ICR Reference No: 202111-0720-001
Status: Historical Active	Previous ICR Reference No: 202106-0720-004
Agency/Subagency: DOW/DODOASHA	Agency Tracking No:
Title: COVID-19 Vaccine Screening and Immunization Documentation
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/22/2021
	Date Received in OIRA: 11/18/2021
Terms of Clearance: The pediatric form was posted publicly for use prior to OMB approval and the burden associated with that form will be reported as a violation of the PRA in the relevant report to Congress.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	08/31/2024	08/31/2024
Responses	4,616,000	0	4,000,000
Time Burden (Hours)	153,866	0	666,667
Cost Burden (Dollars)	4,840,000	0	4,840,000

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	4,616,000	4,000,000	616,000
Annual Time Burden (Hours)	153,866	666,667	-512,801
Annual Cost Burden (Dollars)	4,840,000	4,840,000	0

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Respondent burden for DHA Form 207 decreased due to updated estimation of number of the respondents. Added DHA 236, collection in use without an OMB Control Number.

Annual Cost to Federal Government: $32,290,000

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? Yes

Agency Contact: Kira Starks 571 372-4529 danikquia.k.starks.ctr@mail.mil

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