Application for the Review of Discharge from the Armed Forces of the United States

Forms and Documents

Document Name	Status
Form DD Form 293 Application for the Review of Discharge from the Armed Forces of the United States Form	Modified
PIA Sections 1-2 (2).pdf Supplementary Document	2019-09-24
SSJM for Form 293 (Accepted).pdf Supplementary Document	2019-09-24
Supporting Statement A - 0704-0004 - 10.18.2019.docx Supporting Statement A	2019-10-18

IC Document Collections

IC ID	Document Title	Status
5237	Application for the Review of Discharge from the Armed Forces of the United States Form	Modified

ICR Details

OMB Control No: 0704-0004	ICR Reference No: 201909-0704-008
Status: Active	Previous ICR Reference No: 201410-0704-010
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Application for the Review of Discharge from the Armed Forces of the United States
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/02/2019
	Date Received in OIRA: 10/28/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2022	36 Months From Approved
Responses	10,000	0	0
Time Burden (Hours)	7,500	0	0
Cost Burden (Dollars)	54,375	0	0

---

Abstract: Under Title 10 USC 1553 and DOD Directive 1332.41, "Boards for the Correction of Military Records (BCMRs) and Discharge Review Board (DRBs)," former service members who received an administrative discharge have the right to appeal the characterization or reason for separation provided they do so within 15 years from the date of separation. The DD Form 293, "Application for Review of Discharge or Separation from the Armed Forces of the United States," is the form that allows former Service members to explain the reasons for the alleged error, designate legal counsel, and provides DRBs nevessary information to process requests.

---

Authorizing Statute(s): US Code: 10 USC 1553 Name of Law: null
  

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:
	84 FR 32730	07/09/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 48602	09/16/2019
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
Application for the Review of Discharge from the Armed Forces of the United States	DD Form 293	Application for the Review of Discharge from the Armed Forces of the US.

---

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	10,000	0	0	0	0	10,000
Annual Time Burden (Hours)	7,500	0	0	0	0	7,500
Annual Cost Burden (Dollars)	54,375	0	0	0	0	54,375

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:

---

Annual Cost to Federal Government: $18,466,000

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: 10/28/2019

---