Waiver/Remission of Indebtedness Application

Forms and Documents

Document Name	Status
Form DD2789 Waiver/Remission of Indebtedness Application Form and Instruction	Modified
supporting_statement_a.doc Supporting Statement A	2018-06-01
DD Form 2789 SSN Justification (003).pdf Supplementary Document	2018-05-16

IC Document Collections

IC ID	Document Title	Status
5638	Waiver/Remission of Indebtedness Application Form and Instruction	Modified

ICR Details

OMB Control No: 0730-0009	ICR Reference No: 201805-0730-001
Status: Active	Previous ICR Reference No: 200905-0730-002
Agency/Subagency: DOD/DFAS	Agency Tracking No:
Title: Waiver/Remission of Indebtedness Application
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: 07/02/2018
	Date Received in OIRA: 06/01/2018
Terms of Clearance: DOD must report this collection as a violation in the Information Collection Budget.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2021	36 Months From Approved
Responses	4,500	0	0
Time Burden (Hours)	6,000	0	0
Cost Burden (Dollars)	43,500	0	0

---

Abstract: Information is used to determine an individual's entitlement to relief from a claim owed the U.S. Government. Government claims examiners use information provided to determine whether there is indication of fraud, misrepresentation, and fault on the part of the individual, or whether it's in the best interest of the government to collect debt.

---

Authorizing Statute(s): US Code: 5 USC 5584 Name of Law: Claims for overpayment of pay and allowances, and of travel, transportation and relocation expense
   US Code: 10 USC 2774 Name of Law: Claims for overpayment of pay and allowances and of travel and transportation allowances
   US Code: 10 USC 4837 Name of Law: Settlement of accounts, remission or cancellation of indebtedness of members
   US Code: 10 USC 6161 Name of Law: Settlement of accounts: remission or cancellation of indebtedness of members
   US Code: 10 USC 9837 Name of Law: Settlement of accounts: remission or cancellation of indebtedness of members
   US Code: 32 USC 716 Name of Law: Claims for overpayment of pay and allowances, and travel and transportation allowances
  

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:
	83 FR 8658	02/28/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 25444	06/01/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Waiver/Remission of Indebtedness Application	DD2789	WAIVER/REMISSION OF INDEBTEDNESS APPLICATION

---

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	4,500	0	0	-2,500	0	7,000
Annual Time Burden (Hours)	6,000	0	0	-4,100	0	10,100
Annual Cost Burden (Dollars)	43,500	0	0	43,500	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Number of users of the form as decreased. Electronic subbmission has increased from 20% to 80%. Annual Cost to US Government has decreased.

---

Annual Cost to Federal Government: $148,185

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 06/01/2018

---