Exceptional Family Member Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD Form 2792 Family Member Medical Summary	Form and Instruction	Modified	Available
Form DD Form 2792-1 Special Education/Early Intervention Summary (Special Education)	Form and Instruction	New	Available
Form DD Form 2792 Family Member Medical Summary (Medical Providers)	Form and Instruction	New	Available
Form DD Form 2792-1 Early Intervention/Special Education Summary	Form and Instruction	New	Available
0704-0411_SSA_7.29.2020.DOCX	Supporting Statement A	Uploaded 2020-07-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
5496	DD-2792 Family Member Medical Summary (Family Members)	Form and Instruction	Modified	Family Member Medical Summary
242890	DD 2792-1 Special Education/ Early Intervention Summary (Special Education Teachers)	Form and Instruction	New	Special Education/Early Intervention Summary (Special Education)
242889	DD-2792 Family Member Medical Summary (Medical Providers)	Form and Instruction	New	Family Member Medical Summary (Medical Providers)
242878	DD 2792-1 Early Intervention/Special Education Summary (Family Members)	Form and Instruction	New	Early Intervention/Special Education Summary

ICR Details

OMB Control No: 0704-0411	ICR Reference No: 202007-0704-014
Status: Historical Active	Previous ICR Reference No: 201406-0704-002
Agency/Subagency: DOW/DODDEP	Agency Tracking No:
Title: Exceptional Family Member Program
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: 09/01/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/30/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2023	36 Months From Approved
Responses	98,608	0	0
Time Burden (Hours)	15,617	0	0
Cost Burden (Dollars)	762,699	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 1400
   US Code: 20 USC 921
   PL: Pub.L. 94 - 191 all
  

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	10/24/2018
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
DD 2792-1 Early Intervention/Special Education Summary (Family Members)	DD Form 2792-1	Early Intervention/Special Education Summary
DD 2792-1 Special Education/ Early Intervention Summary (Special Education Teachers)	DD Form 2792-1	Special Education/Early Intervention Summary (Special Education)
DD-2792 Family Member Medical Summary (Family Members)	DD Form 2792	Family Member Medical Summary
DD-2792 Family Member Medical Summary (Medical Providers)	DD Form 2792	Family Member Medical Summary (Medical Providers)

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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	98,608	0	0	54,053	0	44,555
Annual Time Burden (Hours)	15,617	0	0	-4,455	0	20,072
Annual Cost Burden (Dollars)	762,699	0	0	113,796	0	648,903

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: Burden increased due to a general increase in the number of family members filling out both forms. Also, in the previously approved collection the burden for each respondent was consolidated and this time we broke it out to accurately account for the burden on each respondent.

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Annual Cost to Federal Government: $504,247

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:  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: 07/30/2020

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