Case Management Intake

Privacy Act Statement OMB No. 0704-XXXX

OMB approval expires:

Authority: 10 U.S.C. 136, Under Secretary of Defense for Personnel and Readiness; 10 U.S.C. 1781 note, Establishment of Online Resources To Provide Information About Benefits and Services Available to Members of the Armed Forces and Their Families; DoD Directive 1404.10, DoD Civilian Expeditionary Workforce; DoD Instruction (DoDI) 1342.22, Military Family Readiness; and DoDI 6490.06, Counseling Services for DoD Military, Guard and Reserve, Certain Affiliated Personnel, and Their Family Members.

Principal Purpose(s): To document and verify the eligibility of callers and identify your inquiry or issue so that we may provide a warm hand-off, referral and/or requested information. Records may be used as a management tool for statistical analysis, tracking, reporting, and evaluating program effectiveness and conducting research. However, if you indicate you may represent a threat to self or others you will be reported to the appropriate authorities in accordance with DoD/Military Branch of Service and Component regulations and established protocols.

Routine Use(s): In addition to those disclosures general permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records may be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: To authorized DoD MOS contractors for the purpose of responding to Service Member or family member need. To contractors and grantees for the purpose of supporting research studies concerned with the effectiveness of non-medical counseling interventions. To local law enforcement entities for the purpose of intervention to prevent harm to the individual (self) in accordance with DoD/Military Branch of Service and Component regulations and established protocols. Any release of information contained in this system of records outside the DoD under a routine use will be compatible with the purpose(s) for which the information is collected and maintained. The DoD Blanket Routine Uses set forth at the beginning of the Office of the Secretary of Defense (OSD) compilation of systems or records notices may apply to this system.

Disclosure: Voluntary; however, if you do not provide information needed to determine your eligibility for non-medical counseling and specialty consultations you may not be able to receive those services.

________________________________________________________________________________

NOTE: The triage consultant will determine eligibility when the participants calls the call center or the participant will complete an online form requesting non-medical or health and wellness coaching; however, the participant will not have to send the form to a specific address, as the form is built into the skin of the website, so the participant just needs to complete the form and it will be sent to Military OneSource

Agency Disclosure Statement:

The public reporting burden for this collection of information, 0704-0528, is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.