Exchange Employee Management and Pay System

Forms and Documents

Document Name	Status
Form Exchange Form 1700 Exchange Form 1700-012 Form and Instruction	New
Form Exchange Form 1450 Exchange Form 1450-018 Form and Instruction	New
Form Exchange Form 1450 Excahange Form 1450-011 Form and Instruction	New
Supporting Statement A- Exchange Employee Mgmt Pay System(20 Jul 16)(2).DOCX Supporting Statement A	2016-08-11
SSN JUSTIFICATION MEMO(2).PDF Supplementary Document	2016-08-11
PIA - Draft - HUMAN RESOURCE AND PAY(2).PDF Supplementary Document	2016-08-11

IC Document Collections

IC ID	Document Title	Status
222966	Exchange Form 1700-012 Form and Instruction	New
222965	Exchange Form 1450-018 Form and Instruction	New
222963	Excahange Form 1450-011 Form and Instruction	New
222952	Web-based "Health/Benefit Enrollment" (eBenefits) Other-Web-based application	New

ICR Details

OMB Control No: 0702-0139	ICR Reference No: 201608-0702-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOD/DOA	Agency Tracking No:
Title: Exchange Employee Management and Pay System
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/12/2016
	Date Received in OIRA: 08/11/2016
Terms of Clearance: DOD must report this collection in the Information Collection Budget (ICB).

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	36 Months From Approved
Responses	7,650	0	0
Time Burden (Hours)	2,533	0	0
Cost Burden (Dollars)	63,333	0	0

---

Abstract: The Army and Air Force Exchange Service (Exchange) is a Non-Appropriated Fund (NAF) Instrumentality of the United States of America. This information collection is required to process and administer a number of different benefits available to eligible Exchange employees, former employees (retirees), their dependents, beneficiaries, spouses, and ex-spouses. The data collected allows for the accurate and timely processing of all pay, salary, health, retirement, annuities, and beneficiary funds by the Exchange Human Resources (HR) offices and the Finance & Accounting Treasury Benefits department.

---

Authorizing Statute(s): US Code: 10 USC 3013 Name of Law: null
   US Code: 10 USC 8013 Name of Law: null
   US Code: 42 USC 659 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
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 15511	03/23/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 53127	08/11/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Excahange Form 1450-011	Exchange Form 1450-011	Annuity Application
Exchange Form 1700-012	Exchange Form 1700-012	Beneficiary Designation
Exchange Form 1450-018	Exchange Form 1450-018	Application for Payment of Survivor Annuity
Web-based "Health/Benefit Enrollment" (eBenefits)

---

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	7,650	0	0	7,650	0	0
Annual Time Burden (Hours)	2,533	0	0	2,533	0	0
Annual Cost Burden (Dollars)	63,333	0	0	63,333	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 an information collection that was not previously licensed with an OMB Control symbol.

---

Annual Cost to Federal Government: $4,508,357

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: 08/11/2016

---