PEARL HARBOR COMMEMORATIVE MEDAL APPLICATION/INFORMATION

ICR 199101-0704-004

OMB: 0704-0322

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
109124 Migrated
ICR Details
0704-0322 199101-0704-004
Historical Active
DOD/DODDEP
PEARL HARBOR COMMEMORATIVE MEDAL APPLICATION/INFORMATION
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 02/01/1991
Retrieve Notice of Action (NOA) 01/08/1991
  Inventory as of this Action Requested Previously Approved
01/31/1994 01/31/1994
100,000 0 0
33,333 0 0
0 0 0

AUTHORIZED BY P.L. 101-510, VETERANS WHO WERE PRESENT AT HAWAII ON DECEMBER 7, 1941, WHEN IT WAS ATTACKED BY THE JAPANESE AND DOD CIVILIA WHO WERE WOUNDED OR KILLED, MAY REQUEST USE OF THE PEARL HARBOR COMMEMORATIVE MEDAL BY COMPLETING A DOD FORM AND SUBMITTING IT TO AIR SERVICE PERSONNEL RECORDS CENTER. INFORMATION REQUESTED IS BASIC MILITARY/CIVILIAN ADVICE DATA TO BE USED TO VERIFY THEIR ELIGIBILITY

None
None


No

1
IC Title Form No. Form Name
PEARL HARBOR COMMEMORATIVE MEDAL APPLICATION/INFORMATION D 2567

  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 100,000 0 0 100,000 0 0
Annual Time Burden (Hours) 33,333 0 0 33,333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
01/08/1991


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