Emergency Justification Letter

United States Dopartment of State
Washington,

D,C.

2052CI

Aptil2l,?022
Dominic Mancini, Acting Adrainistrator
Office of Information and Regulatory Atrairs
Offhce of Managunent and Budget
Dem Acting Adminisnarcr Mancini,
The Departme.nt of State requests Office of Managenrent and Budget (OMB) Bmergency
processing, pursuant to 5 C.F.R. tr320"13, of the DS-4316, Eligibility Questionnaire for
HAVANA Act Payments, OMB Confsl Numhr 1405-)OfiX.

On October 8,2fr21, the President signed the "Helping American Victims Rffected by
Neurological Attacks" (HAVANA) Act of 2021(Public Law I1746).In this statute, Congress
authorized federal government agencies to make payment to affected current employees, former
employees, and their dependents for qualifring injuries to the brain. This law requires the
Department {and other agencies} to "prescribe regulations" implementing the HAVANA Act not
later than I80 days after the effective date of the Act (which was April 6,2022). The Department
is submitting a draft interim final rule (IFR) for formal review at OIRA, which will fulfill the
mandate of the HAVANA Act, define "qualifying injury to the brain"o and provide procedures
for affected individuals to submit claims.
Pursuant to the procedures outlined in the IFR" a boar&certified neurologist will review a
potential claimant's file and cornplete the DS43l6o the Eligibility Questionnaire for HAVANA

Act Payments, which will provide the required medical zubstantiation for any claims filed
pursuant to the Departnent's implanentation ofthe HAVANA Act" This form requires approval
under the Paperwork Redpction Act,
The Department has determined that:

1.

This collection is necessary without allowing forthe time period nomrally associated
with a routine submission for review under the provisions of the Paperwork Reduction
Act. It is crucial that individuals experiencing qualifring injuries to the brain be
examined and, if appropriate, submit their claims under the Act and receive paymsnt as
soon as possible. In addition, Congress mandated that these procedures be in place by
April 6; therefore, it is critical that the furm be ready for the public to use as soon as the
IFR is published. The IFR provides fsr 30 days of public cornment; in addition, the
Deparffient commits to initiating, within 30 days ofthe emergency Notice of Action, a
request for three-year approval with a 60{ay notice in the Federal Register.

2- This collection

is essential to the mission ofthe Department of State, which is committed
to protecting its employees and dependents from injury; and, to the extent possible,
making a payment to them pursuant to the HAVANA Act for qualifring injuries to the
brain incurred in connection with war, insurgency, hostile act, terrorist activity, or other
incidents designated by the Secretary of State, and which were not the result of the willful
misconduct of the covered individual. The purpose of this collection is to provide
required documenktion from a board-certified neurologist regarding the claimant's
injuries.

3.

The use of normal PRA clearance procedures would prevent the Department from
abtaining this information on a tirnely basis.

In light of the foregoing, the Department of State requests OMB's formal emergency review and
approval of this information collection by April 30,2022.
Sincerely,

I+

V Ornrt-e^.1
Amb. Jonathan M. Moore
Coordinator
Health lncident Response Task Force

vvqv \)(-.
argaret Uyeh
Senior Care Coordinator
Bureau of Global Talent Management