Disposition of Remains - Reimbursable Basis Request for Payment of Funeral and/or Internment Expenses

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD Form 2065 Disposition of Remains - Reimbursable Basis	Form	Modified	Repair queued
Form DD Form 1375 Request for Payment of Funeral and/or Interment Expenses	Form	Modified	Available
0704-0030_SSA_5.7.2019.docx	Supporting Statement A	Uploaded 2019-05-17	Available
SSN Justification Memo - privacy signed.pdf	Supplementary Document	Uploaded 2019-05-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
5249	Disposition of Remains - Reimbursable Basis Request for Payment of Funeral and/or Interment Expenses	Form	Modified	Disposition of Remains - Reimbursable Basis
5249	Disposition of Remains - Reimbursable Basis Request for Payment of Funeral and/or Interment Expenses	Form	Modified	Request for Payment of Funeral and/or Interment Expenses

ICR Details

OMB Control No: 0704-0030	ICR Reference No: 201905-0704-002
Status: Historical Active	Previous ICR Reference No: 201602-0704-001
Agency/Subagency: DOW/DODDEP	Agency Tracking No:
Title: Disposition of Remains - Reimbursable Basis Request for Payment of Funeral and/or Internment Expenses
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/17/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/17/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2022	36 Months From Approved	06/30/2019
Responses	2,450	0	2,450
Time Burden (Hours)	1,225	0	1,224
Cost Burden (Dollars)	8,881	0	12,985

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Abstract: DD Form 2065 records disposition instructions and costs for preparation and final disposition of remains. DD Form 1375 provides the next-of-kin an instrument to apply for reimbursement of funeral/interment expenses. This information is used to adjudicate claims for reimbursement of these expenses.

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Authorizing Statute(s): US Code: 10 USC 1481-1488 Name of Law: Death Benefits
  

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:
	84 FR 2834	02/08/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 22117	05/16/2019
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Disposition of Remains - Reimbursable Basis Request for Payment of Funeral and/or Interment Expenses	DD Form 1375, DD Form 2065	Request for Payment of Funeral and/or Interment Expenses ,   Disposition of Remains - Reimbursable Basis

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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	2,450	2,450	0	0	0	0
Annual Time Burden (Hours)	1,225	1,224	0	0	1	0
Annual Cost Burden (Dollars)	8,881	12,985	0	0	-4,104	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: No

Burden Reduction Due to:

Short Statement: The burden has decreased since the last approval due to a recalculation of the labor cost imposed on respondents.

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Annual Cost to Federal Government: $29,620

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

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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: 05/17/2019

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