OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

DD Form 3112, "Personnel Accountability And Assessment Notification For Corona Virus Disease 2019 (COVID-19) Exposure"

IC 241121 under ICR 202004-0720-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 3112
DD Form 3112, "Personnel Accountability And Assessment Notification For Corona Virus Disease 2019 (COVID-19) Exposure"		 Form and Instruction
3112 Personnel Accountability and Assessment Notification for
DD3112 20200402 locked.pdf
www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd3112.pdf 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 3112 Personnel Accountability and Assessment Notification for Coronavirus Disease 2019 (COVID-19) Exposure DD3112 20200402 locked.pdf https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd3112.pdf Yes Yes Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100,000 0 100,000 0 0 0
Annual IC Time Burden (Hours) 8,333 0 8,333 0 0 0
Annual IC Cost Burden (Dollars) 60,000 0 60,000 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.