Application for a Review by the Physical Disability Board of Review

ICR 202102-0704-014

OMB: 0704-0453

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
0704-0453 202102-0704-014
Received in OIRA 201212-0704-006
DOD/DODDEP
Application for a Review by the Physical Disability Board of Review
Reinstatement with change of a previously approved collection   No
Regular 07/14/2021
  Requested Previously Approved
36 Months From Approved
240 0
180 0
4,860 0

Former members of the Armed Forces who were separated form the Armed Forces during the period beginning on September 11, 2001 and ending on December 31, 2009 due to unfitness for duty due to a medical condition with a disability rating of 20 percent disabled or less and were found to be not eligible for retirement may request a review of the decision. Agency will use information obtained to review the decision in accordance with the requirements in 10 USC 1554(a) for fairness and accuracy.

US Code: 10 USC 1554(a)
  
US Code: 10 USC 1554(a)

Not associated with rulemaking

  85 FR 32373 05/29/2020
86 FR 37139 07/14/2021
No

1
IC Title Form No. Form Name
Application for a Review by the Physical Disability Board of Review DD Form 294 Application for a Review by the Physical Disability Board of Review

  Total Request 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 240 0 0 -1,560 0 1,800
Annual Time Burden (Hours) 180 0 0 -1,170 0 1,350
Annual Cost Burden (Dollars) 4,860 0 0 4,860 0 0
No
Yes
Miscellaneous Actions
Decrease in burden due to a decrease in the number of respondents

$260,520
No
    No
    No
No
No
No
No
LaTarsha Yeargins 571 372-2089 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
07/14/2021


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