Exceptional Family Member Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD 2792 Family Member Medical Summary: Family Members	Form and Instruction	Modified	Repair queued
Form DD 2792-1 Special Education/Early Intervention Summary: Special Education Teachers	Form and Instruction	New	Repair queued
Form DD 2792-1 Special Education/Early Intervention Summary: Family Members	Form and Instruction	New	Repair queued
Form DD 2792 Family Member Medical Summary: Medical Providers	Form and Instruction	New	Repair queued
0704-0411_DDES.pdf	Supplementary Document	Uploaded 2020-06-05	Available
0704-0411_SSA_6.5.2020.DOCX	Supporting Statement A	Uploaded 2020-06-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
5496	Family Member Medical Summary: Family Members	Form and Instruction	Modified
242178	Special Education/Early Intervention Summary: Special Education Teachers	Form and Instruction	New
242177	Special Education/Early Intervention Summary: Family Members	Form and Instruction	New
242175	Family Member Medical Summary: Medical Providers	Form and Instruction	New

ICR Details

OMB Control No: 0704-0411	ICR Reference No: 202005-0704-002
Status: Historical Inactive	Previous ICR Reference No: 201406-0704-002
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Exceptional Family Member Program
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 07/23/2020
	Date Received in OIRA: 06/05/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved
Responses	44,555	0	0
Time Burden (Hours)	20,072	0	0
Cost Burden (Dollars)	648,903	0	0

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Abstract: This information collection requirement is necessary to screen members of military families to determine if they have special medical (DD Form 2792) and/or educational (DD Form 2792-1) conditions so that these conditions can be taken into consideration when the Service member is being assigned to a new location with his/her family. The information is used by the personnel system to identify special considerations for future assignments.

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Authorizing Statute(s): US Code: 20 USC 921 Name of Law: null
   PL: Pub.L. 94 - 191 all Name of Law: null
   US Code: 20 USC 1400 Name of Law: null
  

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:
	83 FR 53615	12/24/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 25408	05/01/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Family Member Medical Summary: Family Members	DD 2792	Family Member Medical Summary
Family Member Medical Summary: Medical Providers	DD 2792	Family Member Medical Summary
Special Education/Early Intervention Summary: Family Members	DD 2792-1	Special Education / Early Intervention Summary
Special Education/Early Intervention Summary: Special Education Teachers	DD 2792-1	Special Education/Early Intervention Summary

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Overall number of respondents has increased from 44,555 to 98,608. This is due to a general increase in the number of family members filling out both forms. Additionally, 14,708 Special Education Teachers are now filling out DD 2792-1, in addition to Family Members. Three IC's have been added to the collection as Family Members are filling out both DD 2792 and 2792-1. Medical Providers and Special Education Teachers are filling out DD 2792 and DD 2792-1, respectively. The addition of the three IC's has been done to more accurately describe who is filling out each form.

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Annual Cost to Federal Government: $862,546

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? No

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Common Form ICR:  Yes

Description/Changes for Common Form Usage: 

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 06/05/2020

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