Information Collection

Personnel Accountability and Assessment for a Public Health Emergency

IC 241131 under ICR 202103-0720-001 · OMB 0720-0067.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0067 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD Form 3112 Personnel Accountability and Assessment for a Public Health Emergency	Form
DD Form 3112 Personnel Accountability and Assessment for a Public hea DD3112 draft 20201016.pdf www.esd.whs.mil/Directives/forms/	Form
DD Form 3112 Personnel Accountability and Assessment for a Public hea DD3112 draft 20201016.pdf www.esd.whs.mil/Directives/forms/	Form

IC Title:

Personnel Accountability and Assessment for a Public Health Emergency

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DD Form 3112	Personnel Accountability and Assessment for a Public health Emergency	DD3112 draft 20201016.pdf	https://www.esd.whs.mil/Directives/forms/	Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	8,333	8,333
Annual IC Cost Burden (Dollars)	60,000	60,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.