Application for Former Spouse Payments from Retired Pay

Forms and Documents

Document Name	Status
Form DD Form 2293 Application for Former Spouse Payments from Retired Pay Form and Instruction	Modified
DD 2293 - SSN Memo Cont..pdf Supplementary Document	2017-02-21
DD 2293 - SSN Memo.pdf Supplementary Document	2017-02-21
Supporting Statement Part A.docx Supporting Statement A	2017-02-21

IC Document Collections

IC ID	Document Title	Status
5635	Application for Former Spouse Payments from Retired Pay Form and Instruction	Modified

ICR Details

OMB Control No: 0730-0008	ICR Reference No: 201702-0730-002
Status: Historical Active	Previous ICR Reference No: 201307-0730-001
Agency/Subagency: DOD/DFAS	Agency Tracking No:
Title: Application for Former Spouse Payments from Retired Pay
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/28/2017
	Date Received in OIRA: 02/24/2017
Terms of Clearance: This collection must be reported in this year's Information Collection Budget.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved
Responses	25,000	0	0
Time Burden (Hours)	12,500	0	0
Cost Burden (Dollars)	90,625	0	0

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Abstract: This form provides a uniform method for applicants to provide statutorily required information when seeking payments under the Uniform Services Former Spouse's Protection Act (10 U.S.C. 1408). The former spouse must request direct payment on court ordered child support, alimony, or division of property to a former spouse from the retired pay of a Uniformed Service Member.

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Authorizing Statute(s): US Code: 10 USC 1408 Name of Law: Payment of Retired or Retainer Pay in Compliance with Court Orders
  

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:
	81 FR 22239	04/15/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 11192	02/21/2017
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
Application for Former Spouse Payments from Retired Pay	DD Form 2293	Application for Former Spouse Payments From Retired Pay

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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	25,000	0	0	-4,127	0	29,127
Annual Time Burden (Hours)	12,500	0	0	5,218	0	7,282
Annual Cost Burden (Dollars)	90,625	0	0	-73,651	0	164,276

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 reinstatement with change of previously approved collection for which approval has expired. Total burden hours have increased from 6,722 to 12,500 based on increased time to complete form and gather supporting documents. Time to gather supporting documentation was not previously taken into account. The estimated time of completion was increased from 15 minutes to 30 minutes

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Annual Cost to Federal Government: $346,850

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: 02/24/2017

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