Forms Relating to Military Service Records

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NA Form 13177 Check the Status of a Clinical & Medical Treatment Records Request	Form and Instruction	Unchanged	Available
Form NA Form 13075 Questionnaire about Military Service	Form and Instruction	Unchanged	Available
Form NA Form 13055 Request for Information Needed to Reconstruct Medical Data	Form and Instruction	Unchanged	Available
Form NA Form 13042 Request for Information Needed to Locate Medical Records	Form and Instruction	Unchanged	Available
Form NA Form 13036 Authorization for Release of Military Medical Patient Records	Form and Instruction	Unchanged	Available
Form NA Form 13177 Follow-up to Request for Clinical & Medical Treatment Records	Form and Instruction	Unchanged	Repair queued
2020SupportingStatement_3095_0039FINAL.docx	Supporting Statement A	Uploaded 2020-06-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
32546	Forms Relating to Military Service Records	Form and Instruction	Unchanged	Check the Status of a Clinical & Medical Treatment Records Request
32546	Forms Relating to Military Service Records	Form and Instruction	Unchanged	Questionnaire about Military Service
32546	Forms Relating to Military Service Records	Form and Instruction	Unchanged	Request for Information Needed to Reconstruct Medical Data
32546	Forms Relating to Military Service Records	Form and Instruction	Unchanged	Request for Information Needed to Locate Medical Records
32546	Forms Relating to Military Service Records	Form and Instruction	Unchanged	Authorization for Release of Military Medical Patient Records
214198	Follow-up to Request for Clinical & Medical Treatment Records	Form and Instruction	Unchanged	Follow-up to Request for Clinical & Medical Treatment Records

ICR Details

OMB Control No: 3095-0039	ICR Reference No: 202006-3095-004
Status: Historical Active	Previous ICR Reference No: 201706-3095-004
Agency/Subagency: NARA	Agency Tracking No:
Title: Forms Relating to Military Service Records
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: 08/06/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/23/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2023	12 Months From Approved	08/31/2020
Responses	133,000	0	133,000
Time Burden (Hours)	11,067	0	11,067
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection is used by individuals and interested private and public sector agencies in order to obtain information from military service records.

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Authorizing Statute(s): None

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:
	85 FR 19778	04/08/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 36425	06/16/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Follow-up to Request for Clinical & Medical Treatment Records	NA Form 13177	Follow-up to Request for Clinical & Medical Treatment Records
Forms Relating to Military Service Records	NA Form 13036, NA Form 13055, NA Form 13075, NA Form 13177, NA Form 13042	Authorization for Release of Military Medical Patient Records ,   Request for Information Needed to Locate Medical Records ,   Request for Information Needed to Reconstruct Medical Data ,   Questionnaire about Military Service ,   Check the Status of a Clinical & Medical Treatment Records Request

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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	133,000	133,000	0	0	0	0
Annual Time Burden (Hours)	11,067	11,067	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	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:

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Annual Cost to Federal Government: $0

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.     No

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:  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: 06/23/2020

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