Application for a Review by the Physical Disability Board of Review

Forms and Documents

Document Name	Status
Form DD Form 294 Application for a Review by the Physical Disability Board of Review Form	Modified
DD 294_SSN Justification_Approved.PDF Supplementary Document	2021-06-23
0704-0453_SSA_7.14.2021.docx Supporting Statement A	2021-07-14

IC Document Collections

IC ID	Document Title	Status
187660	Application for a Review by the Physical Disability Board of Review Form	Modified

ICR Details

OMB Control No: 0704-0453	ICR Reference No: 202102-0704-014
Status: Received in OIRA	Previous ICR Reference No: 201212-0704-006
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Application for a Review by the Physical Disability Board of Review
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/14/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	240	0
Time Burden (Hours)	180	0
Cost Burden (Dollars)	4,860	0

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Abstract: 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.

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Authorizing Statute(s): US Code: 10 USC 1554(a)
  

Citations for New Statutory Requirements: US Code: 10 USC 1554(a)

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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 32373	05/29/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 37139	07/14/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 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

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ICR Summary of Burden

	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

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Decrease in burden due to a decrease in the number of respondents

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Annual Cost to Federal Government: $260,520

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.     No

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: 07/14/2021

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