Declaration and Dissolution of a Same-Sex Domestic Partnership

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD Form X653 Declaration and Dissolution of Same Sex Domestic Partnership	Form	New	Repair queued
Supporting Statement 082913.doc	Supporting Statement A	Uploaded 2013-08-29	Repair queued
DEERS SORN.pdf	Supplementary Document	Uploaded 2013-05-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207136	Declaration and Dissolution of Same Sex Domestic Partnership	Form	New

ICR Details

OMB Control No:	ICR Reference No: 201305-0704-006
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Declaration and Dissolution of a Same-Sex Domestic Partnership
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: 08/30/2013
OIRA Conclusion Action: Withdrawn	Conclusion Date: 10/25/2013
	Date Received in OIRA: 08/22/2013
Terms of Clearance: At the request of the Department, this rule has been withdrawn from OMB review.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		6 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: In order to provide benefits to the same-sex domestic partners of eligible DoD civilian employees and other eligible individuals, the DoD will collect information in the DEERS database which establishes eligibility and terminates eligibility for benefits. The current information collection supplies the necessary eligibility information to verify eligibility for DEERS enrollment and dependent ID card issuance, and to terminate eligibility.

Emergency Justfication: The Department of Defense has identified family member and dependent benefits that may lawfully be provided to same-sex domestic partners of eligible DoD civilian employees and other eligible individuals and their children through modifications to DoD policies and regulations. These benefits shall be extended to same-sex domestic partners and, where applicable, children of same-sex domestic partners, once the DoD civilian or other eligible individual and their same-sex domestic partner have signed the appropriate declaration attesting to the establishment of their same-sex domestic partnership.

---

Authorizing Statute(s): US Code: 10 USC 113 Name of Law: null
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Declaration and Dissolution of Same Sex Domestic Partnership	DD Form X653, DD Form X654	Declaration of a Same-Sex Domestic Partneship for DEERS Enrollment ,   Dissolution of a Same_Sex Domestic Partnership for DEERS Termination

---

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: New collection. DoD has identified family member and dependent benefits that may lawfully be provided to same-sex domestic partners of eligible DoD civilian employees and other eligible individuals and their children through modifications to DoD policies and regulations. These benefits shall be extended to same-sex domestic partners and, where applicable, children of same-sex domestic partners, once DoD civilian or other eligible individual and their same-sex domestic partner have signed the appropriate declaration attesting to the establishment of their same-sex domestic partnership. Additionally, the June 26, 2013, Supreme Court Decision in the United States v. Windsor, which found Section 3 of the Defense of Marriage Act unconstitutional, imposed new responsibilities on DoD that must be addressed immediately. This decision provided the avenue for the extension of Federal benefits to the same-sex spouses of DoD military members and civilian employees. In an August 13, 2013 memorandum, "Extending Benefits to Same-Sex Spouses of Military Members," the Secretary of Defense directed that, ". . . spousal and family benefits, including identification cards, will be made available to same-sex spouses no later than September 3, 2013. In order to meet the September 3 date to provide benefits to same-sex spouses as soon after the Windsor decision as possible, as well as benefits to same-sex partners of DoD civilian employees, DoD has requested emergency processing of this information collection, and to have the Federal Register notice requirements waived. A Federal Register notice will be published in the Federal Register prior to the submission of a subsequent information collection package to OMB under regular processing timeframes.

---

Annual Cost to Federal Government: $2,871

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

---

Common Form ICR:  No

---

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: 08/22/2013

---