Application for Surrogate Association for DoD Self-Service (DS) Logon

Forms and Documents

Document Name	Status
Form DD Form 3005 Application for Surrogate Association for DoD Self-Service (DS) Logon Form Form	Modified
SSN Justification_DPCLTD.pdf Supplementary Document	2021-06-29
SSN Justification for DEERS.pdf Supplementary Document	2021-06-29
0704-0559_SSA_9.20.21.docx Supporting Statement A	2021-09-20
DMDC02_PIA_Sections 1-2_7.23.2021.pdf Supplementary Document	2021-07-23

IC Document Collections

IC ID	Document Title	Status
223842	Application for Surrogate Association for DoD Self-Service (DS) Logon Form Form	Modified

ICR Details

OMB Control No: 0704-0559	ICR Reference No: 202106-0704-013
Status: Received in OIRA	Previous ICR Reference No: 201807-0704-005
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Application for Surrogate Association for DoD Self-Service (DS) Logon
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/28/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2021
Responses	5,000	5,000
Time Burden (Hours)	500	167
Cost Burden (Dollars)	13,600	9,870

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Abstract: This form is submitted to DoD to establish a Defense Enrollment Eligibility Reporting System (DEERS) record and surrogate association for issuance of a DoD Self-Service (DS) Logon. A surrogate may be established: (1) As the custodian of an unmarried minor child(ren) of a deceased Service member who is under age 18, who is at least 18 but under 23 and attending school full-time, or who is incapacitated. (2) As the agent of an incapacitated dependent (e.g., spouse, parent). (3) As the agent of a wounded, ill, or incapacitated Service member.

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Authorizing Statute(s): US Code: 10 USC 1044a
  

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:
	86 FR 39009	07/23/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 52135	09/20/2021
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 Surrogate Association for DoD Self-Service (DS) Logon Form	DD Form 3005	Application for Surrogate Association for DoD Self-Service (DS) Logon

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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	5,000	5,000	0	0	0	0
Annual Time Burden (Hours)	500	167	0	333	0	0
Annual Cost Burden (Dollars)	13,600	9,870	0	3,730	0	0

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: No

Burden Reduction Due to:

Short Statement: Burden increased due to an increase in respondent's response time.

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Annual Cost to Federal Government: $3,863

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: 09/28/2021

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