Consent to Conduct Installation Records Check Draft PIA

PRIVACY IMPACT ASSESSMENT (PIA)
PRESCRIBING AUTHORITY: DoD Instruction 5400.16, "DoD Privacy Impact Assessment (PIA) Guidance". Complete this form for Department of Defense
(DoD) information systems or electronic collections of information (referred to as an "electronic collection" for the purpose of this form) that collect, maintain, use,
and/or disseminate personally identifiable information (PII) about members of the public, Federal employees, contractors, or foreign nationals employed at U.S.
military facilities internationally. In the case where no PII is collected, the PIA will serve as a conclusive determination that privacy requirements do not apply to
system.
1. DOD INFORMATION SYSTEM/ELECTRONIC COLLECTION NAME:

DoD Consent to Conduct Installation Records Check
3. PIA APPROVAL DATE:

2. DOD COMPONENT NAME:

Under Secretary of Defense for Personnel and Readiness

SECTION 1: PII DESCRIPTION SUMMARY (FOR PUBLIC RELEASE)
a. The PII is: (Check one. Note: foreign nationals are included in general public.)
From members of the general public

From Federal employees and/or Federal contractors

From both members of the general public and Federal employees and/or
Federal contractors

Not Collected (if checked proceed to Section 4)

b. The PII is in a: (Check one)
New DoD Information System

New Electronic Collection

Existing DoD Information System

Existing Electronic Collection

Significantly Modified DoD Information System
c. Describe the purpose of this DoD information system or electronic collection and describe the types of personal information about individuals
collected in the system.

The information collection requirement is necessary to obtain consent from impacted individuals to conduct an installation records check
(IRC) of the Family Advocacy Program (FAP) Central Registry and military law enforcement records and the Defense Central Index of
Investigations (DCII) to determine suitability to work with children under 18 years of age in DoD Child Care Services Program. Impacted
individuals include: employees, applicants for employment, contractors, volunteers, Family Child Care (FCC) providers, and adult family
members of FCC providers residing in the home.
d. Why is the PII collected and/or what is the intended use of the PII? (e.g., verification, identification, authentication, data matching, mission-related use,
administrative use)

Sensitive information being collected is authorized by 34 USC 20351, the Crime Control Act of 1990, and DoDI 1402.05, Criminal History
Background Checks on Individuals in Child Care Service Programs. It is used to determine an individual’s suitability or fitness for working
with children.
e. Do individuals have the opportunity to object to the collection of their PII?

Yes

No

Yes

No

(1) If "Yes," describe the method by which individuals can object to the collection of PII.
(2) If "No," state the reason why individuals cannot object to the collection of PII.

f. Do individuals have the opportunity to consent to the specific uses of their PII?
(1) If "Yes," describe the method by which individuals can give or withhold their consent.
(2) If "No," state the reason why individuals cannot give or withhold their consent.

g. When an individual is asked to provide PII, a Privacy Act Statement (PAS) and/or a Privacy Advisory must be provided. (Check as appropriate and
provide the actual wording.)
Privacy Act Statement

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Privacy Advisory

Not Applicable

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PRIVACY ACT STATEMENT
AUTHORITY: 34 U.S.C. 20351 (Crime Control Act of 1990); DoDI 1402.05, Background Checks on Individuals in DoD Child Care
Services Programs; and E.O. 9397 (SSN), as amended.
PRINCIPAL PURPOSE(S): To require all individuals who provide child care services, as defined by Section 20351 of 34 U.S.C. (Crime
Control Act of 1990), to undergo an Installation Records Check (IRC). Impacted individuals include (but are not limited to) employees
(appropriated fund, non-appropriated fund, and local nationals), military personnel (Active, Reserve, and National Guard), contractors
(regular and recurring), in-home care providers (to include respite care, foster care, family child care providers (FCC) and other adults
residing in the households), and volunteers that have regular and reoccurring contact with children under 18 years of age.
ROUTINE USES: The Routine Uses are listed in the applicable system of records notices found at:
DoD: Defense Central Index of Investigations (DCII), DMDC 13 DoD
(https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570716/dmdc-13-dod/), DITPR #6697
Army: A0215-3 SAMR, NAF Personnel Records (https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/
Article/570010/a0215-3-samr/), DITPR #593 and,
A0690-200 DAPE, Department of the Army Civilian Personnel System (https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORNArticle-view/Article/570099/a0690-200-dape/), DITPR #6080
Navy and Marine Corps: NM01754-3, DON Child and Youth Program (https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORNArticle-View/Article/570428/nm01754-3/), DITPR #NM01754-3
Air Force: F034 AF SVA C, Child Development/Youth Programs Records (https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wideSORN-Article-View/Article/569755/f034-af-sva-c/), DITPR #11299.
Defense Logistics Agency: S400.20, Day Care Facility Registrant, Applicant, and Enrollee Records (https://dpcld.defense.gov/Privacy/
SORNsIndex/DOD-wide-SORN-Article-View/Article/570257/s40020/),
National Security Agency: GNSA 19, National Security Agency/Central Security Service (https://dpcld.defense.gov/Privacy/SORNsIndex/
DOD-wide-SORN-Article-View/Article/570520/gnsa-19/).
Once completed, the form will be maintained by the human resource (HR) or security offices.
DISCLOSURE: Voluntary; however, failure to provide all the requested information could preclude employment or continued service in a
Child Care Services Program position and may form the basis for withdrawal of a tentative (conditional) job offer, removal from a position
and/or the federal service or prohibition from working with or around children.
h. With whom will the PII be shared through data exchange, both within your DoD Component and outside your Component? (Check all that apply)
Within the DoD Component

Specify.

Other DoD Components

Specify.

Other Federal Agencies

Specify.

State and Local Agencies

Specify.

Contractor (Name of contractor and describe the language in
the contract that safeguards PII. Include whether FAR privacy
clauses, i.e., 52.224-1, Privacy Act Notification, 52.224-2,
Privacy Act, and FAR 39.105 are included in the contract.)

Specify.

Other (e.g., commercial providers, colleges).

Specify.

i. Source of the PII collected is: (Check all that apply and list all information systems if applicable)
Individuals

Databases

Existing DoD Information Systems

Commercial Systems

Other Federal Information Systems

j. How will the information be collected? (Check all that apply and list all Official Form Numbers if applicable)

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E-mail

Official Form (Enter Form Number(s) in the box below)

Face-to-Face Contact

Paper

Fax

Telephone Interview

Information Sharing - System to System

Website/E-Form

Other (If Other, enter the information in the box below)

k. Does this DoD Information system or electronic collection require a Privacy Act System of Records Notice (SORN)?
A Privacy Act SORN is required if the information system or electronic collection contains information about U.S. citizens or lawful permanent U.S. residents that
is retrieved by name or other unique identifier. PIA and Privacy Act SORN information must be consistent.
Yes

No

If "Yes," enter SORN System Identifier

DMDC 13 DoD

SORN Identifier, not the Federal Register (FR) Citation. Consult the DoD Component Privacy Office for additional information or http://dpcld.defense.gov/
Privacy/SORNs/
or
If a SORN has not yet been published in the Federal Register, enter date of submission for approval to Defense Privacy, Civil Liberties, and Transparency
Division (DPCLTD). Consult the DoD Component Privacy Office for this date
If "No," explain why the SORN is not required in accordance with DoD Regulation 5400.11-R: Department of Defense Privacy Program.

l. What is the National Archives and Records Administration (NARA) approved, pending or general records schedule (GRS) disposition authority
for the system or for the records maintained in the system?
(1) NARA Job Number or General Records Schedule Authority.
(2) If pending, provide the date the SF-115 was submitted to NARA.

(3) Retention Instructions.

m. What is the authority to collect information? A Federal law or Executive Order must authorize the collection and maintenance of a system of
records. For PII not collected or maintained in a system of records, the collection or maintenance of the PII must be necessary to discharge the
requirements of a statue or Executive Order.
(1) If this system has a Privacy Act SORN, the authorities in this PIA and the existing Privacy Act SORN should be similar.
(2) If a SORN does not apply, cite the authority for this DoD information system or electronic collection to collect, use, maintain and/or disseminate PII.
(If multiple authorities are cited, provide all that apply).
(a) Cite the specific provisions of the statute and/or EO that authorizes the operation of the system and the collection of PII.
(b) If direct statutory authority or an Executive Order does not exist, indirect statutory authority may be cited if the authority requires the
operation or administration of a program, the execution of which will require the collection and maintenance of a system of records.
(c) If direct or indirect authority does not exist, DoD Components can use their general statutory grants of authority (“internal housekeeping”) as
the primary authority. The requirement, directive, or instruction implementing the statute within the DoD Component must be identified.

n. Does this DoD information system or electronic collection have an active and approved Office of Management and Budget (OMB) Control
Number?
Contact the Component Information Management Control Officer or DoD Clearance Officer for this information. This number indicates OMB approval to
collect data from 10 or more members of the public in a 12-month period regardless of form or format.
Yes

No

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Pending
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(1) If "Yes," list all applicable OMB Control Numbers, collection titles, and expiration dates.
(2) If "No," explain why OMB approval is not required in accordance with DoD Manual 8910.01, Volume 2, " DoD Information Collections Manual:
Procedures for DoD Public Information Collections.”
(3) If "Pending," provide the date for the 60 and/or 30 day notice and the Federal Register citation.

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