System Authorization Access Request Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD2875 System Authorization Access Request	Form	New	Available
Form DD2875 System Authorization Access Request	Form	New	Repair queued
0704-SAAR_SSA_3.29.22.docx	Supporting Statement A	Uploaded 2022-03-29	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
252258	System Authorization Access Request	Form	New	System Authorization Access Request
252258	System Authorization Access Request	Form	New

ICR Details

OMB Control No: 0704-0630	ICR Reference No: 202203-0704-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOW/DODDEP	Agency Tracking No: 0704-SAAR
Title: System Authorization Access Request Form
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/02/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/29/2022
Terms of Clearance: DOD needs to report this collection as part of their submission to the Information Collection Budget.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2025	36 Months From Approved
Responses	7,200,000	0	0
Time Burden (Hours)	600,000	0	0
Cost Burden (Dollars)	16,242,000	0	0

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Abstract: DD Form 2875 documents the data elements necessary for validating the trustworthiness of individuals requesting access to Department of Defense systems and information. Executive Order 10450 “Security Requirements for Government Employment” establishes the security requirements for government employment. The requestor’s security requirements (background investigation and clearance information) are identified on the DD Form 2875 and validated by the cognizant Security Manager. Collection of the requestor’s security requirements information ensures that any system access granted is consistent with the interests of national security.

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Authorizing Statute(s): EO: EO 10450 Name/Subject of EO: Security Requirements for Government Employment
  

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 60006	10/29/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 17277	03/28/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
System Authorization Access Request	DD2875	System Authorization Access Request

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	7,200,000	0	0	7,200,000	0	0
Annual Time Burden (Hours)	600,000	0	0	600,000	0	0
Annual Cost Burden (Dollars)	16,242,000	0	0	16,242,000	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: Existing collection in use without an OMB number.

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Annual Cost to Federal Government: $64,968,000

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: 03/29/2022

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