Screening and Monitoring of DoD Personnel Deployed to Ebola Outbreak Areas

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD Form 2991 Ebola Virus Disease Redeployment Risk Assessment and Medical Clearance	Form and Instruction	Modified	Available
Form DD Form 2990 Ebola Virus Desease Exposure Risk Evlauation	Form and Instruction	Modified	Available
Supporting Statement_ Regular OMB submission_0720-0056revisionApril2015.doc	Supporting Statement A	Uploaded 2015-04-28	Available
SORN_A0400-5a DASG DoD.pdf	Supplementary Document	Uploaded 2014-10-17	Available
SSN Justification for Ebola Forms.doc	Supplementary Document	Uploaded 2014-10-17	Available
USD_P&R_Memo.pdf	Supplementary Document	Uploaded 2014-10-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213534	Screening and Monitoring of DoD Personnel Deployed to Ebola Outbreak Areas	Form and Instruction	Modified	Ebola Virus Disease Redeployment Risk Assessment and Medical Clearance
213534	Screening and Monitoring of DoD Personnel Deployed to Ebola Outbreak Areas	Form and Instruction	Modified	Ebola Virus Desease Exposure Risk Evlauation

ICR Details

OMB Control No: 0720-0056	ICR Reference No: 201502-0720-001
Status: Historical Active	Previous ICR Reference No: 201410-0720-001
Agency/Subagency: DOW/DODOASHA	Agency Tracking No:
Title: Screening and Monitoring of DoD Personnel Deployed to Ebola Outbreak Areas
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: 05/08/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/25/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved	05/31/2015
Responses	2,400	0	2,400
Time Burden (Hours)	480	0	480
Cost Burden (Dollars)	14,438	0	14,438

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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.

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Authorizing Statute(s): EO: EO 13295
   US Code: 10 USC 136(b)
  

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:
	79 FR 65928	11/06/1014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 10074	02/25/2015
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
Screening and Monitoring of DoD Personnel Deployed to Ebola Outbreak Areas	DD Form 2990, DD Form 2991	Ebola Virus Desease Exposure Risk Evlauation ,   Ebola Virus Disease Redeployment Risk Assessment and Medical Clearance

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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	2,400	2,400	0	0	0	0
Annual Time Burden (Hours)	480	480	0	0	0	0
Annual Cost Burden (Dollars)	14,438	14,438	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: $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: 02/25/2015

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