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View ICR - OIRA Conclusion

OMB Control No: 0720-0055	ICR Reference No: 202210-0720-001
Status: Historical Active	Previous ICR Reference No: 201908-0720-002
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: Third Party Collection Program (Insurance Information)
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: 10/24/2022
	Date Received in OIRA: 10/24/2022
Terms of Clearance: This is approved for one year pending rulemaking.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2023	36 Months From Approved	10/31/2022
Responses	5,797,500	0	5,910,000
Time Burden (Hours)	386,500	0	394,000
Cost Burden (Dollars)	11,328,315	0	10,933,500

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	5,797,500	5,910,000	-112,500
Annual Time Burden (Hours)	386,500	394,000	-7,500
Annual Cost Burden (Dollars)	11,328,315	10,933,500	394,815

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The number of respondents slightly decreased and the burdens of the collection instruments were separated, causing the burden of the DD Form 2569 to decrease. However, the annual burden cost increased since the previous approval due to an increase in the hourly wage of the respondents.

Annual Cost to Federal Government: $8,159,015

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: Brandon Kim 703 344-6832 brandon.h.kim8.ctr@mail.mil

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