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:
0720-0075
ICR Reference No:
202401-0720-002
Status:
Active
Previous ICR Reference No:
Agency/Subagency:
DOD/DODOASHA
Agency Tracking No:
0720-EFMP
Title:
Travis Air Force Base Exceptional Family Member Program (EFMP) Pilot Program Evaluation Survey
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
04/17/2024
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/12/2024
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2027
36 Months From Approved
Responses
240
0
0
Time Burden (Hours)
80
0
0
Cost Burden (Dollars)
1,826
0
0
Abstract:
David Grant Medical Center is taking part in a pilot program for EFMP family members. The goal of this pilot program is to connect EFMP families with quality medical and non-medical resources to support and care for their family members. In this pilot program, EFMP family members at David Grant are being provided with “Care Maps” that identify resources tailored to their diagnoses. The intent of this web-based survey is to solicit feedback on the efficacy and usefulness of these resources, as well as feedback from EFMP families at David Grant that have not received specialized maps to understand their experience in obtaining EFMP care without said resources
Authorizing Statute(s):
US Code:
10 USC 1781c
Name of Law: Office of Special Needs
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:
88 FR 72439
10/20/2023
30-day Notice:
Federal Register Citation:
Citation Date:
89 FR 17444
03/11/2024
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Exceptional Family Member Program(EFMP) Pilot Program Evaluation at Travis Air Force Base Survey
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
240
0
0
240
0
0
Annual Time Burden (Hours)
80
0
0
80
0
0
Annual Cost Burden (Dollars)
1,826
0
0
1,826
0
0
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:
This is a new information collection with a new associated burden.
Annual Cost to Federal Government:
$509
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
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.
No
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.
No
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:
Amanda Grifka 555 555-5555 amanda.b.grifka.civ@health.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:
03/12/2024
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