Exceptional Family Member Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD-2792-1 Exceptional Family Member Special Education/Early Intervention Summary	Form	Modified	Available
Form DD-2792 Exceptional Family Member Medical History	Form	Modified	Available
0704-0411 SS Part A.doc	Supporting Statement A	Uploaded 2011-01-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
5496	Exceptional Family Member Program	Form	Modified	Exceptional Family Member Special Education/Early Intervention Summary
5496	Exceptional Family Member Program	Form	Modified	Exceptional Family Member Medical History

ICR Details

OMB Control No: 0704-0411	ICR Reference No: 201101-0704-002
Status: Historical Active	Previous ICR Reference No: 200608-0704-007
Agency/Subagency: DOW/DODDEP	Agency Tracking No:
Title: Exceptional Family Member Program
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: 03/02/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/31/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2014	36 Months From Approved	03/31/2011
Responses	43,332	0	43,332
Time Burden (Hours)	19,460	0	19,460
Cost Burden (Dollars)	672,513	0	672,512

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Abstract: The Department of Defense screens DOD family members prior to a Service member or Federal employee being assigned to an overseas location. DD Form 2792 will be completed by physicians for family members who have been identified with a special medical need. DD 2792-1 will be completed by school personnel for children who habe a special educational need. The information will be used to determine if the medical and educational resources required by the family member are available overseas.

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Authorizing Statute(s): US Code: 20 USC 1400
   US Code: 20 USC 921
   PL: Pub.L. 94 - 191 all
  

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:
	74 FR 57151	11/04/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 57151	11/04/2009
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
Exceptional Family Member Program	DD-2792, DD-2792-1	Exceptional Family Member Medical History ,   Exceptional Family Member Special Education/Early Intervention Summary

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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	43,332	43,332	0	0	0	0
Annual Time Burden (Hours)	19,460	19,460	0	0	0	0
Annual Cost Burden (Dollars)	672,513	672,512	0	1	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: $467,240

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]? No

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: 01/31/2011

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