Application for a Review by the Physical Disability Board of Review

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD Form 294 Application for a Review by the Physical Disability Board of Review	Form	Modified	Available
Justification for Change.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2009-01-07	Available
Revised STATEMENT OF DETERMINATION (Emergency) sh (2).doc	Supplementary Document	Uploaded 2008-12-29	Available
DD294 Supporting Statement.doc	Supporting Statement A	Uploaded 2010-04-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
187660	Application for a Review by the Physical Disability Board of Review	Form	Modified

ICR Details

OMB Control No: 0704-0453	ICR Reference No: 201003-0704-014
Status: Historical Active	Previous ICR Reference No: 200901-0704-002
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Application for a Review by the Physical Disability Board of Review
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/15/2010
	Date Received in OIRA: 03/31/2010
Terms of Clearance: This collection is approved with the understanding DOD will re-submit in one year addressing the passback provided to the Department on April 30, 2010. In particular, the privacy act section needs to be re-write to address the blanket routine uses and provide a link to any relevant documents. This collection can be re-submitted without a 60 day notice.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2011	36 Months From Approved	06/30/2010
Responses	850	0	1,800
Time Burden (Hours)	638	0	1,350
Cost Burden (Dollars)	0	0	0

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Abstract: Former members of the Armed Forces who were separated form the Armed Forces during the period beginning on September 11, 2001 and ending on December 31, 2009 due to unfitness for duty due to a medical condition with a disability rating of 20 percent disabled or less and were found to be not eligible for retirement may request a review of the decision. Agency will use information obtained to review the decision in accordance with the requirements in 10 USC 1554(a) for fairness and accuracy.

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Authorizing Statute(s): US Code: 10 USC 1554(a) Name of Law: null
  

Citations for New Statutory Requirements: US Code: 10 USC 1554(a) Name of Law: null

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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:
	74 FR 69331	12/31/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 69331	12/31/2009
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
Application for a Review by the Physical Disability Board of Review	DD Form 294	Application for a Review by the Physical Disability Board of Review

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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	850	1,800	0	0	-950	0
Annual Time Burden (Hours)	638	1,350	0	0	-712	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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:

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]? No

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)? No

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: 03/31/2010

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