Claim Certification and Voucher for Death Gratuity Payment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD Form 397 Claim Certification and Voucher for Death Gratuity Payment	Form	New	Available
DD Form 397 SUPPORTING STATEMENT.doc	Supporting Statement A	Uploaded 2008-09-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
186640	Claim Certification and Voucher for Death Gratuity Payment	Form	New	Claim Certification and Voucher for Death Gratuity Payment

ICR Details

OMB Control No: 0730-0017	ICR Reference No: 200809-0730-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOW/DFAS	Agency Tracking No:
Title: Claim Certification and Voucher for Death Gratuity Payment
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/31/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/18/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2011	36 Months From Approved
Responses	2,416	0	0
Time Burden (Hours)	1,208	0	0
Cost Burden (Dollars)	27,675	0	0

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Abstract: This information collection allows the government to collect the signatures and information needed to pay a death gratuity. Pursuant to 10 U.S.C. 1475 – 1480, a designated beneficiary(ies) or next-of-kin can receive a death gratuity payment for a deceased service member. The DD Form 397 serves as a record of the disbursement of the death gratuity. To provide internal controls for this benefit, and to comply with the above-cited statutes, the information requested is needed to substantiate the receipt of the benefit.

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Authorizing Statute(s): US Code: 10 USC 1475 – 1480
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 73777	12/28/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 31438	06/02/2008
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Claim Certification and Voucher for Death Gratuity Payment	DD Form 397	Claim Certification and Voucher for Death Gratuity Payment

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ICR Summary of Burden

table that charts list 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	2,416	0	0	0	0	2,416
Annual Time Burden (Hours)	1,208	0	0	0	0	1,208
Annual Cost Burden (Dollars)	27,675	0	0	0	0	27,675

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

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: $28,907

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: 09/18/2008

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