Application for Survivor Access Card

Forms and Documents

Document Name	Status
Form IMCOM Form 44 Application for Survivor Access Card (IMCOM Form 44) Form and Instruction	New
0702-SACA_SSA_12.28.2021.docx Supporting Statement A	2021-12-28
0702-SACA_PIA_9.9.2020.pdf Supplementary Document	2021-12-27
0702-SACA_DraftSORN_9.6.2019.DOCX Supplementary Document	2021-12-01

IC Document Collections

IC ID	Document Title	Status
250614	Application for Survivor Access Card (IMCOM Form 44) Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202112-0702-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DOD/DOA	Agency Tracking No: 0702-SACA
Title: Application for Survivor Access Card
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/28/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	670	0
Time Burden (Hours)	670	0
Cost Burden (Dollars)	4,858	0

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Abstract: In accordance with AR 190-13, the Army Physical Security Program permits eligible Surviving Family members of deceased personnel to have unescorted access to Army installations via the Survivor Access Card in order for them to receive services, attend events, view memorials, and similar activities. Eligible survivors are those who meet the eligibility criteria to receive the Gold Star Lapel Button or Next of Kin Lapel Button. Eligible Survivors must first contact the installation level Survivor Outreach Services (SOS) support coordinator to verify eligibility and coordinate issuance of an installation access credential. The Application for Survivor Access Card (IMCOM Form 44) is obtained by eligible Surviving Family members from SOS staff members. Eligible family members complete the form to obtain the Survivor Access Card which grants Survivors ease of access to military installations.

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Authorizing Statute(s): PL: Pub.L. 109 - 163 562 Name of Law: National Defense Authorization Act for Fiscal Year 2006
   PL: Pub.L. 115 - 232 626 Name of Law: John S. McCain National Defense Authorization Act for Fiscal Year 2019
  

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 54948	10/05/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 72581	12/22/2021
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 Survivor Access Card (IMCOM Form 44)	IMCOM Form 44	Application for Survivor Access Card

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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	670	0	0	670	0	0
Annual Time Burden (Hours)	670	0	0	670	0	0
Annual Cost Burden (Dollars)	4,858	0	0	4,858	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: This is a new collection with a new associated burden.

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Annual Cost to Federal Government: $23,551

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: 12/28/2021

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