Screening and Monitoring of DoD Personnel Deployed to Ebola Outbreak Areas

Forms and Documents

Document Name	Status
Form DD Form 2990 Screening and Monitoring of DoD Personnel Deployed to Ebola Outbreak Areas Form	New
SORN_A0400-5a DASG DoD.pdf Supplementary Document	2014-10-17
SSN Justification for Ebola Forms.doc Supplementary Document	2014-10-17
Supporting Statement_ Ebola Virus Disease Screening and Monitoring Forms.doc Supporting Statement A	2014-10-17
USD_P&R_Memo.pdf Supplementary Document	2014-10-17

IC Document Collections

IC ID	Document Title	Status
213534	Screening and Monitoring of DoD Personnel Deployed to Ebola Outbreak Areas Form	New

ICR Details

OMB Control No: 0720-0056	ICR Reference No: 201410-0720-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: Screening and Monitoring of DoD Personnel Deployed to Ebola Outbreak Areas
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: 10/23/2014
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/22/2014
	Date Received in OIRA: 10/17/2014
Terms of Clearance: This collection is approved for six months only. If this collection will be used longer than 6 months DOD must go through the regular notice and comment process.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2015	6 Months From Approved
Responses	2,400	0	0
Time Burden (Hours)	480	0	0
Cost Burden (Dollars)	14,438	0	0

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Abstract: DoD personnel deployed to CDC-defined Ebola outbreak areas will be screened and monitored for exposure to Ebola Virus Disease (EVD) on an ongoing basis throughout their deployment. Individuals who report exposure to EVD while deployed will be evaluated by a healthcare professional to determine their level of exposure. DD Forms 2990 and 2991 will be used for these purposes.

Emergency Justfication: The 2 forms will be used to ensure DoD personnel deployed in support of Operation UNITED ASSISTANCE are promptly evaluated for exposure(s) to the Ebola virus within 12 hours prior to departing an Ebola outbreak country or region (West Africa). Ebola is a Quarantinable Communicable Disease as named in Executive Order 13295 and may necessitate quarantine and isolation to protect the individual and the health of the public.

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Authorizing Statute(s): US Code: 10 USC 136(b) Name of Law: null
   EO: EO 13295 Name/Subject of EO: null
  

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

Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Screening and Monitoring of DoD Personnel Deployed to Ebola Outbreak Areas	DD Form 2990, DD Form 2991	Ebola Virus Disease Exposure Risk Evaluation ,   Ebola Virus Disease Redeployment Risk Assessment and Medical Clearance

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ICR Summary 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	2,400	0	0	2,400	0	0
Annual Time Burden (Hours)	480	0	0	480	0	0
Annual Cost Burden (Dollars)	14,438	0	0	14,438	0	0

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: This is a new collection.

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Annual Cost to Federal Government: $220,000

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: 10/17/2014

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