0704-0396 SS Part A

Supporting Statement For

Department Of Defense Medical Examination Review Board (DoDMERB)

OMB 0704-0396

A. JUSTIFICATION

1. Need for the Information Collection

The Department of Defense Medical Examination Review Board (DoDMERB) is responsible for scheduling and evaluating medical examination for all applicants to the Amy, Air Force, Navy, Coast Guard, and Merchant Marine Academies, the Reserve Officer Training Corps (ROTC) Programs, and the Uniformed Services University of the Health Sciences (USUHS). The collection of medical history of each candidate is to determine if applicants meet medical standards as outlined in Department of Defense Directive 6130,3, Physical Standards for Appointment, Enlistment and Induction, 15 Dec 2000. The authority for using the Department of Defense forms is AFJI36-2018, Medical Examination of Applicants for United States Service Academies, Reserve Officer Training Corps (ROTC) Scholarship Programs, including 2-and 3-Year College Scholarship Programs (CSP),and the Uniformed Services University of the Health Sciences (USUHS), 20 Oct 1989.

2. Use of Information

Collection of medical history is accomplished by sending each applicant a scheduling package that includes all of the forms that are required to get a DoDMERB physical examination completed. This package is sent by DoDMERB and its Contractor, Concorde, Inc., and it is used to determine if the applicant meets medical standards to qualify for one of the Service academies, or ROTC programs.

3. Use of Technology

Collection of information does not involve the use of automated electronic, mechanical, or other technological collection techniques or other forms of information technology, as an example, permitting electronic submission responses. Automated technology has been considered, but is not feasible. Scheduling packages include the various examination and medical history forms and are sent throughout the United States (and overseas for applicants who may be residing outside the United States).

However, all the DD Forms are available on the DoD Forms Web site at http://www.dtic.mil/whs/directives/infomgt/forms/formsprogram.htm in fillable/printable ADOBE pdf format.

4. Non-duplication

DoDMERB is a one of a kind organization within the Department of Defense and there is no other organization within the Department of Defense or any other federal agency that would collect this information.

5. Burden on Small Business

Collection of information does not impact small business or any other small entities.

6. Less Frequent Collections

The consequence of not collecting this information is that applicants to the programs cannot be admitted, and scholarships/stipends cannot be awarded. Collection of this information cannot be done less frequently. It is collected at the time the applicant applies to one of the programs. There is no current technology that could accomplish the task of collecting the medical history forms. Applicants must meet physical standards contained in DoD Directive 6130.3 to accept an appointment to one of the programs; therefore, legal obstacles cannot be reduced or changed.

7. Paperwork Reduction Act Guidelines

There are no special circumstances. The collection of information will be conducted in a manner consistent with the guidelines in 5 CFR 1320.5(d)(2).

8. Consultation and Public Comments

The 60-day Federal Register notice was published on 27 June 2006, (Volume 71, Number 123, Pages 36524-36525). Copy attached. No comments were received. Efforts are made to consult with persons outside the agency annually during the Medical Accessions Working Group conducted annually involving representatives of the Service academies, surgeons general, and ROTC programs. Applicants may comment through telephone or written response anytime during the process of their medical history. When received, the agency promptly reviews any comments and determines the feasibility of the comments.

9. Gifts or Payments

No payment or gifts are provided to respondents.

10. Confidentiality

Applicant information is not released to any unauthorized persons, organizations, or agencies without express written authorization from the applicant if 18 years of age or older, or if under legal age, the parent(s) or legal guardian(s). Destruction of information collected is accomplished only by authorized government methods. Normal method used is shredding the information.

11. Sensitive Questions

No sensitive questions are asked in this collection of information.

12. Respondent Burden and its Costs

a. The annual hour burden for respondents is 30,000 hours. This was derived by taking the number of respondents, approximately 30,000, then multiplying this figure by the 60 minutes required by the candidate to complete forms.

b. The annual cost to respondents is $300,000. This was derived by taking the number of respondents, approximately 30,000, and multiplying this figure by $10.00, the average hourly rate of a student and 60 minutes.

Number of Respondents: 30,000

Frequency of Response: 1

Total Annual Response: 30,000

Minutes per Response: 60

Total Burden Hours: 30,000

13. Cost of Respondent Burden

There are no capital or start-up costs associated with this information collection.

14. Cost to the Federal Government

a. Total cost to the Federal Government is estimated at $465,000. This is based on the average hourly wage of ($30) and the appropriate amount of time (1/2 hour) spent on each response. One half of an hour X ($30 per hour) X 30,000 responses = $450,000. Also included in the total is $15,000 estimated for overhead and printing.

b. The total cost to the Government:

Printing and overhead costs = $15,000

Personnel cost = $450,000 ($30 per hour) X 30,000 forms X (1/2 hour per form)

Total $465,000

15. Reasons for Change in Burden

There are no program changes or adjustments.

16. Collections of Information

The results for collection of this information will not be published.

17. Expiration Date

The Air Force is not seeking an exception not to display the expiration date of this information collection.

18. Certification Statement

There are no exceptions to the certification statement.

B. COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS

Statistical methods are not employed for this collection of information.