USMC Child and Youth Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NAVMC 1750/11 USMC Child and Youth Programs Controlled Medication Authorization, Administration Record and Daily Log	Form and Instruction	Modified	Available
Form NAVMC 1750/10 USMC Child and Youth Programs Medication Authorization and Administration Record	Form and Instruction	Modified	Available
Form NAVMC 1750/7 USMC Child and Youth Programs Non-Medicated Topical Products Authorization	Form and Instruction	Modified	Available
Form NAVMC 1750/4 USMC Child and Youth Programs Health Assessment	Form	Modified	Available
Form NAVMC 11720 USMC Family Care Programs Consent to Release Information	Form	Modified	Available
Form NAVMC 1750/5 USMC Child and Youth Programs Registration Form	Form and Instruction	Modified	Available
Form NAVMC 1750/5 USMC Child and Youth Programs Forms	Form and Instruction	Modified	Repair queued
USMC CYP_Parent Handbook.pdf	Supplementary Document	Uploaded 2022-08-08	Repair queued
0703-0068_SSA_8.23.2022.docx	Supporting Statement A	Uploaded 2022-08-23	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
228240	USMC Child and Youth Programs Forms	Form and Instruction	Modified	USMC Child and Youth Programs Controlled Medication Authorization, Administration Record and Daily Log
228240	USMC Child and Youth Programs Forms	Form and Instruction	Modified	USMC Child and Youth Programs Medication Authorization and Administration Record
228240	USMC Child and Youth Programs Forms	Form and Instruction	Modified	USMC Child and Youth Programs Non-Medicated Topical Products Authorization
228240	USMC Child and Youth Programs Forms	Form	Modified	USMC Child and Youth Programs Health Assessment
228240	USMC Child and Youth Programs Forms	Form	Modified	USMC Family Care Programs Consent to Release Information
228240	USMC Child and Youth Programs Forms	Form and Instruction	Modified	USMC Child and Youth Programs Registration Form
228240	USMC Child and Youth Programs Forms	Form and Instruction	Modified

ICR Details

OMB Control No: 0703-0068	ICR Reference No: 202206-0703-004
Status: Historical Active	Previous ICR Reference No: 202011-0703-001
Agency/Subagency: DOW/NAVY	Agency Tracking No:
Title: USMC Child and Youth Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/30/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/23/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2025	36 Months From Approved	01/31/2024
Responses	247,500	0	112,000
Time Burden (Hours)	115,917	0	131,040
Cost Burden (Dollars)	4,028,104	0	2,320,640

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Abstract: The information collection is necessary to manage the general health status of patrons participating in Child and Youth Programs (CYP) and to register patrons for CYP. The information collected in the Health Assessment is used by USMC CYP and Inclusion Action Team (IAT) personnel to determine the general health status of patrons participating in CYP activities and, as required, the appropriate accommodations for the patron to ensure full enjoyment of the CYP services. The information collection is also needed to obtain authorization for CYP personnel to administer non-medicated topical products, maintain the medication administration record, controlled medication administration record, and daily log for USMC CYP participants.

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Authorizing Statute(s): US Code: 10 USC 5041 Name of Law: Headquarters, Marine Corps
   US Code: 10 USC 5013 Name of Law: Secretary of the Navy
   US Code: 10 USC 88, Subch. II Name of Law: Military Family Programs and Military Child Care: Military Child Care
   EO: EO 9397 Name/Subject of EO: SSN
  

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:
	87 FR 4006	01/26/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 51654	08/23/2022
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
USMC Child and Youth Programs Forms	NAVMC 1750/10, NAVMC 1750/11, NAVMC 1750/7, NAVMC 1750/4, NAVMC 11720, NAVMC 1750/5	USMC Child and Youth Programs Registration Form ,   USMC Family Care Programs Consent to Release Information ,   USMC Child and Youth Programs Health Assessment ,   USMC Child and Youth Programs Non-Medicated Topical Products Authorization ,   USMC Child and Youth Programs Medication Authorization and Administration Record ,   USMC Child and Youth Programs Controlled Medication Authorization, Administration Record and Daily Log

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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	247,500	112,000	0	135,500	0	0
Annual Time Burden (Hours)	115,917	131,040	0	-15,123	0	0
Annual Cost Burden (Dollars)	4,028,104	2,320,640	0	1,707,464	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Respondent time burden has decreased since the last submission despite the addition of three forms. This is because NAVMC 11720 was incorrectly identified as having 112,000 respondents when, in practice, only a small percentage of parents/guardians complete the form. Despite the decrease in time burden, the Labor Cost of Respondent Burden has increased due to revised average hourly wage estimates which were previously too low.

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Annual Cost to Federal Government: $582,863

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: 08/23/2022

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