Department of Defense Khamisiyah Survey

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
5578	Department of Defense Khamisiyah Survey	Migrated

ICR Details

OMB Control No: 0720-0012	ICR Reference No: 199612-0720-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: Department of Defense Khamisiyah Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 12/24/1996
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/30/1996
	Date Received in OIRA: 12/05/1996
Terms of Clearance: This emergency PRA submission is approved for use through 06/97. OMB suggests, however, that DoD carefully evaluates the adequacy of the response space provided for certain questions. For example, OMB recommends that DoD expand the space provided for responses to question 4 regarding additional units within 50 km of Khamisiyah. In addition, OMB expects DoD to pursue all follow up procedures as outlined in its December 19, 1996 memo, even if response rates are higher than expected for early mailing waves. OMB believes that if DoD conscientiously follows these procedures the response rates are likely to exceed DoD's estimate.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/1997	06/30/1997
Responses	13,783	0	0
Time Burden (Hours)	1,608	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection is necessary to facilitate investigation of the events surrounding the demolition of munitions at Khamisiyah, Iraq, during the period March 1-15, 1991. The information collected will be used to verify the respondent's location, learn about demolition-related events that may have been observed, encourage enrollment in a DoD or DVA clinical program, and to contribute to a better understanding of the events during and after the Gulf War and potential health consequences. Respondents for this collection are 13,783 Persian Gulf War veterans who are not serving on active duty.

Emergency Justfication:

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Department of Defense Khamisiyah Survey

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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	13,783	0	0	13,783	0	0
Annual Time Burden (Hours)	1,608	0	0	1,608	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 12/05/1996

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