DoD Consolidated Adjudications Facility Request for Records

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DoD CAF Form 3 DoD CAF Form 3: Request for Records	Form and Instruction	New	Available
TAB 1 - SSPA for 0704-AAJJ 11.15.2016.docx	Supporting Statement A	Uploaded 2016-11-16	Available
TAB 1b - SSN Justification Memo.pdf	Supplementary Document	Uploaded 2016-11-15	Available
TAB 1a - PIA - CAF Request for Record.pdf	Supplementary Document	Uploaded 2016-11-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
224416	DoD CAF Form 3: Request for Records	Form and Instruction	New

ICR Details

OMB Control No: 0704-0561	ICR Reference No: 201611-0704-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOD/DODDEP	Agency Tracking No: 0704-AAJJ
Title: DoD Consolidated Adjudications Facility Request for Records
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: 12/19/2016
	Date Received in OIRA: 11/18/2016
Terms of Clearance: This collection should be reported by DOD in the Information Collection Budget.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	36 Months From Approved
Responses	120	0	0
Time Burden (Hours)	10	0	0
Cost Burden (Dollars)	232	0	0

---

Abstract: The request for records form is provided to standardize collection of data elements specific to requesting DoD CAF records in accordance with the Privacy Act of 1974. Standardization will decrease the burden on the requester to provide additional required information in order to perfect requests for records and permit the DoD CAF Privacy Act Office to positively verify the identity of requesters thereby ensuring records are not inappropriately released to third parties.

---

Authorizing Statute(s): US Code: 5 USC 552a Name of Law: null
   US Code: 10 USC 113 Name of Law: null
   EO: EO 9397 Name/Subject of EO: 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:
	80 FR 74770	11/30/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 80048	11/15/2016
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
DoD CAF Form 3: Request for Records	DoD CAF Form 3	Request for Records

---

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	120	0	0	0	0	120
Annual Time Burden (Hours)	10	0	0	0	0	10
Annual Cost Burden (Dollars)	232	0	0	0	0	232

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:

---

Annual Cost to Federal Government: $11,369

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: 11/18/2016

---