SUPPORTING STATEMENT – PART A
Physician Certificate for Child Annuitant – 0730-0011
A. JUSTIFICATION
1. Need for the Information Collection
10 U.S.C., “Armed Forces,” sections 1435, “Eligible Beneficiaries,” and 1447, “Definitions,” gives the Defense Finance and Accounting Service (DFAS) the authority to offer the Survivor Benefit Plan (SBP) and the Retired Serviceman’s Family Protection Plan (RSFPP), which provides for the coverage of children who are unmarried and incapable of self-support because of mental and/or physical incapacitation. In accordance with DoD Financial Management Regulation (FMR), Volume 7B, Chapter 46, “Survivor Benefit Plan – Annuity Amount and Offsets,” states that a medical certification must be submitted to DFAS every two years for an incapacitated child over 18 years of age; unless medical prognosis indicates the disability is permanent.
2. Use of the Information
The DD Form 2828, “Physician Certificate for Child Annuitant,” is required bi-annually for re-certification of annuitants that were originally determined to have a “temporary” incapacitation. The system generates the form and is mailed to the trustee or guardian of incapacitated child annuitant. The trustee or guardian is required to complete their part of the form and to obtain certification from the physician indicating that the temporary incapacitation is still valid. If form is not completed fully, a request is sent to the trustee or guardian of incapacitated child annuitant, along with the original form. This request is being submitted as part of the submission package. The trustee or guardian returns the completed form by mail to address indicated on form. DFAS reviews form to determine continued eligibility or cancellation of annuity. Technician annotates that form was received, updates disability status and when the next update is required. The form is then archived into the Retired and Annuitant Pay Information DRAS (RAPID) imaging system. If form is not returned, with physician certification, the annuity payment is suspended.
The form is available on both the DoD Forms website (http://www.dtic.mil/whs/directives/forms/index.htm) and the DFAS website (www.dfas.mil). The Privacy Act Statement and Agency Disclosure Notice are available to the respondent on the form.
3. Use of Information Technology
0% electronic submissions are received. This is a bi-annual re-certification of an incapacitated annuitant and requires the wet signatures of respondents. DD Form 2828 is available in fillable PDF format from the DoD Forms Repository. Respondents may complete the form online, print and mail the completed form for processing.
4. Non-duplication
The information obtained through this collection is unique and is not already available for use or adaptation from another cleared source.
This information collection does not impose a significant economic impact on a substantial number of small business or entities.
6. Less Frequent Collection
If DFAS does not receive the information, entitlement is discontinued. The requirement to complete the form ensures and helps alleviate the opportunity for fraud and abuse of member benefits.
7. Paperwork Reduction Act Guidelines
This collection of information does not require collection to be conducted in a manner inconsistent with the guidelines delineated in 5 CFR 1320.5(d)(2).
8. Consultation and Public Comments
Part A: PUBLIC NOTICE
A 60-day Federal Register Notice for the collection published on Monday, April 11, 2016. The 60-day FRN citation is 81 FR 21326. No comments were received during the 60-day comment period.
A 30-day Federal Register Notice for the collection published on Wednesday March 29, 2017. The 30-day FRN citation is 82 FR 15518.
Part B: CONSULTATION
No additional consultation apart from soliciting public comments through the 60-day Federal Register Notice was conducted for this submission.
No payments or gifts are being offered to respondents as an incentive to participate in the collection
10. Confidentiality
Respondents are assured confidentiality, to the extent provided by law, via the Privacy Act Statement on the form. DFAS certifies that the information collected is maintained in accordance with the Privacy Act of 1974, and OMB Circular A-130, Management of Federal Information Resources.
SORN covered by this system is:
T7347b, Defense Military Retiree and Annuitant Pay System at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570196/t7347b/.
PIA covered by this system is:
http://www.dfas.mil/dam/jcr:4c735dde-6b84-4f24-8153-bd83643c98b1/PIA_DRAS_2010.pdf.
Records Retention: Disposition for Retired and Annuitant Pay records range from 30 days to 56 years. The administrative records such as, change of address, electronic messages or tax records, that are not pay affecting, are destroyed using retention of 30 days to less than years. All pay affecting documents such as retirement documents, account computation information or entitlement/eligibility records are retained for six years or more and the pay histories are retained for 56 years. Records are destroyed by tearing, shredding, pulping, macerating, burning, or degaussing the electronic storage media.
11. Sensitive Questions
Disclosure of the Social Security Number (SSN) is used for positive identification due to the payment of a benefit. A justification memo is being submitted as part of the OMB submission package.
12. Respondent Burden, and its Labor Costs
a. Estimation of Respondent Burden
Estimation of Respondent Burden Hours |
|||||
|
Number of Respondents |
Number of Responses per Respondent |
Number of Total Annual Responses |
Response Time (Amount of time needed to complete the collection instrument) |
Respondent Burden Hours (Total Annual Responses multiplied by Response Time) Please compute these into hours) |
DD 2828, Physician Certificate for Child Annuitant |
240 |
1 |
240 |
1 hour |
240 hours |
Total |
240 |
1 |
240 |
1 hour |
240 hours |
b. Labor Cost of Respondent Burden
Labor Cost of Respondent Burden |
|||||
|
Number of Responses |
Response Time per Response |
Respondent Hourly Wage * |
Labor Burden per Response (Response Time multiplied by Respondent Hourly Wage) |
Total Labor Burden (Number of Responses multiplied by Response Time multiplied by Respondent Hourly Wage) |
DD 2828, Physician Certificate for Child Annuitant (Trustee or Guardian) |
120 |
1 hour |
$7.25 |
$7.25 |
$870.00 |
DD 2828, Physician Certificate for Child Annuitant (Physician) |
120 |
1 hour |
$90.00 |
$90.00 |
$10,800.00 |
Total |
240 |
2 hours |
$24 |
$47 |
$11,670.00 |
*The Trustee/Guardian respondent wage was determined by using the federal minimum wage website (https://www.dol.gov/whd/minimumwage.htm)
The Physician respondent wage was determined by using the Bureau of Labor Statistics website (https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm)
13. Respondent Costs Other Than Burden Hour Costs
There are no start-up or capital costs, to the respondents. There is a postage cost of $.49 per trustee/guardian in order for respondent to return completed form. Total cost is $58.80.
14. Cost to the Federal Government
|
DD Form 2828, Physician Certificate for Child Annuitant |
Total |
Number of Responses |
120 |
120 |
Processing Time Per Response (in hours) |
.25 hour |
.25 hour |
Hourly Wage of Worker(s) Processing Responses (Federal Civil Service 2017 Pay Structure)* |
$15.50 |
$15.50 |
Cost to Process Each Response (Processing Time Per Response multiplied by Hourly Wage of Worker(s) Processing Responses) |
$3.875 |
$3.875 |
Total Cost to Process Responses (Cost to Process Each Response multiplied by Number of Responses |
$465.00 |
$465.00 |
*Federal Civil Service 2017 Pay Structure (https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2017/GS_h.pdf)
Operational and Maintenance Costs |
||||||
Equipment |
Printing* |
Postage** |
Software Purchases |
Licensing Costs |
Other |
Total |
|
$7.20 |
$58.80 |
|
|
|
$66.00 |
*Printing is based on 120 forms x $.06 costs to print form equaling $7.20.
**Postage is based on mailing 120 forms x $.49 equaling $58.80.
Total Cost to the Federal Government |
||
Operational and Maintenance Costs |
Labor Cost to the Federal Government |
Total Cost (O&M Costs + Labor Cost) |
$66.00 |
$465.00 |
$531.00 |
15. Reasons for Change in Burden
This is a reinstatement with change to an expired collection. Change is due to previously reporting on only one respondent. It has been updated to include both the physician and trustee/guardian. There was no change in time to complete the form.
16. Publication of Results
The results of this information collection will not be published.
17. Non-Display of OMB Expiration Date
We are not seeking approval to omit the display of the expiration date of the OMB approval on the collection instrument.
18. Exceptions to "Certification for Paperwork Reduction Submissions"
We are not requesting any exemptions to the provisions stated in 5 CFR 1320.9.
| File Type | application/msword |
| File Title | 0730-0011 DD 2828_supporting_statement final |
| Author | Patricia Toppings |
| Last Modified By | Daniel Urchick |
| File Modified | 2017-03-29 |
| File Created | 2017-03-29 |