0704-pacm_4.22.25

0704-PACM_4.22.25.docx

Pentagon Athletic Center Membership Application

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SUPPORTING STATEMENT - PART A

Pentagon Athletic Center Membership Application

0704-PACM


1. Need for the Information Collection

The Pentagon Athletic Center (PAC) serves as a fitness facility and community hub for Department of Defense (DoD) military and civilian employees. As a non-appropriated fund activity operated by Washington Headquarters Services, the PAC requires members to complete a Membership Agreement form.


The Membership Agreement serves as a contractual understanding between the PAC and its members. It outlines rights, responsibilities, and expectations related to membership, dues, access, and conduct. By completing this form, members acknowledge their commitment to adhere to PAC policies and contribute to maintaining a safe and supportive fitness environment.


5 U.S.C. Chapter 79, Services to Employees; 5 U.S.C. 7901, Health Service Programs; 10 U.S.C. 113, Secretary of Defense; DoD Directive 5105.53, Director of Administration and Management; DoD Directive 5110.4 Washington Headquarters Services; and DoD Instruction 1010.10, Health Promotion and Disease Prevention.


The PAC uses the information provided on the form for membership administration, eligibility determination, and account management. The authority ensures that the PAC can effectively serve its members and maintain accurate records.


2. Use of the Information

The respondents are individuals who wish to become members of the Pentagon Athletic Center. These individuals include Department of Defense (DoD) military personnel, civilian employees, contractors, and retirees. Respondents complete the information collection process to apply or renew their membership at the PAC. This membership allows the participants to access the fitness facilities and community services offered by the PAC. The primary collection instrument is the WHS Form 19 “Pentagon Athletic Center Membership Application". Respondents can access the collection instrument in the following ways; In-Person: They can obtain a physical copy of the form from the PAC facility. Downloadable PDF: The form is available for download from the PAC website and submit it via email. Once a form is completed, it is processed by a staff member who then inputs the information from the form into the membership database


3. Use of Information Technology

Currently, 2% is collected electronically from respondents who download the online instrument and return the instrument via email.


A higher electronic submission rate over 75% is not possible until the database, which stores member information, has been modified to accept electronic applications. Future plans are in place to increase the overall number of electronic responses. The database which stores the member application information is being modified to include the ability for members to complete application forms for membership online.

4. Non-duplication

The information obtained through this collection is unique and is not already available for use or adaptation from another cleared source.


5. Burden on Small Businesses

This information collection does not impose a significant economic impact on a substantial number of small businesses or entities.


6. Less Frequent Collection

Collection frequency is as needed since new members are required to complete an application form upon arrival at the facility. This occurs on a day-to-day basis. Members are required to renew memberships on a monthly, semi-annual, and annual basis.


7. Paperwork Reduction Act and Other Guidelines
This collection of information does not require collection to be conducted in a manner inconsistent with the guidelines delineated in 5 CFR 1320.5(d)(2) or other policy.

8. Consultation and Public Comments

Part A: PUBLIC NOTICE

A 60-Day Federal Register Notice (FRN) for the collection published on Tuesday, December 10, 2024. The 60-Day FRN citation is 89 FRN 99236.

No comments were received during the 60-Day Comment Period.

A 30-Day Federal Register Notice for the collection published on Monday, April 28, 2025. The 30-Day FRN citation is 90 FR 17582.

Part B: CONSULTATION
No additional consultation apart from soliciting public comments through the Federal Register was conducted for this submission.

9. Gifts or Payment

No payments or gifts are being offered to respondents as an incentive to participate in the collection.


10. Confidentiality

The Privacy Act is required and is located at the top of the form.


A draft copy of the SORN has been provided with this package for OMB’s review.


A copy of the PIA, PACMA, has been provided with this package for OMB’s review.


The record schedule: Temporary. Cut off and destroy upon immediate collection once the temporary credential or card is returned for potential reissuance due to nearing expiration or not to exceed 6 months from the time of issuance or when the individual no longer requires access, whichever is sooner.


11. Sensitive Questions

No questions considered sensitive are being asked in this collection.


12. Respondent Burden and its Labor Costs

Part A: ESTIMATION OF RESPONDENT BURDEN


  1. Collection Instrument(s)

WHS Form 19

  1. Number of Respondents: 3,436

  2. Number of Responses Per Respondent: 1

  3. Number of Total Annual Responses: 3,436

  4. Response Time: 10 minutes

  5. Respondent Burden Hours: 573 hours


  1. Total Submission Burden

    1. Total Number of Respondents: 3,436

    2. Total Number of Annual Responses: 3,436

    3. Total Respondent Burden Hours: 573 hours


Part B: LABOR COST OF RESPONDENT BURDEN


  1. Collection Instrument(s)

WHS Form 19

  1. Number of Total Annual Responses: 3,436

  2. Response Time: 10 minutes

  3. Respondent Hourly Wage: $16

  4. Labor Burden per Response: $2.67

  5. Total Labor Burden: $9,163


  1. Overall Labor Burden

    1. Total Number of Annual Responses: 3,436

    2. Total Labor Burden: $9,163


The Respondent hourly wage was determined by using the Department of Labor Wage Website [http://www.dol.gov/dol/topic/wages/index.htm].


13. Respondent Costs Other Than Burden Hour Costs

There are no annualized costs to respondents other than the labor burden costs addressed in Section 12 of this document to complete this collection.


14. Cost to the Federal Government


Part A: LABOR COST TO THE FEDERAL GOVERNMENT


  1. Collection Instrument(s)

WHS Form 19

  1. Number of Total Annual Responses: 3,436

  2. Processing Time per Response: 10 minutes

  3. Hourly Wage of Worker(s) Processing Responses: $9.13

  4. Cost to Process Each Response: $1.52

  5. Total Cost to Process Responses: $5,228.45


  1. Overall Labor Burden to the Federal Government

    1. Total Number of Annual Responses: 3,436

    2. Total Labor Burden: $5,228.45


Part B: OPERATIONAL AND MAINTENANCE COSTS


  1. Cost Categories

    1. Equipment: $0

    2. Printing: $5,000

    3. Postage: $0

    4. Software Purchases: $0

    5. Licensing Costs: $0

    6. Other: $0


  1. Total Operational and Maintenance Cost: $5,000


Part C: TOTAL COST TO THE FEDERAL GOVERNMENT


  1. Total Labor Cost to the Federal Government: $5,228.45


  1. Total Operational and Maintenance Costs: $5,000


  1. Total Cost to the Federal Government: $10,5228.45


15. Reasons for Change in Burden

This is a new collection with a new associated burden.



16. Publication of Results

The results of this information collection will not be published.


17. Non-Display of OMB Expiration Date

We are not seeking approval to omit the display of the expiration date of the OMB approval on the collection instrument.


18. Exceptions to “Certification for Paperwork Reduction Submissions”

We are not requesting any exemptions to the provisions stated in 5 CFR 1320.9.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKaitlin Chiarelli
File Modified0000-00-00
File Created2025-06-05

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