Navy Casualty Assistance Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OPNAV 1770/3 Next of Kin Identification	Form	Modified	Available
Form OPNAV 1770/3 OPNAV 1770/3 Next of Kin Identification	Form	Modified	Repair queued
Form OPNAV 1770/2 Next of Kin Travel Request	Form	Modified	Available
Form OPNAV 1770/2 OPNAV 1770/2 Next of Kin Travel Request	Form	Modified	Repair queued
Form OPNAV 1770/1 Consent to Release Personal Information	Form	Modified	Available
Form OPNAV 1770/1 OPNAV 1770/1 Consent to Release Personal Information	Form	Modified	Repair queued
0703-0076_SSN Memo_OPNAV 1770-3_5.10.2022.pdf	Supplementary Document	Uploaded 2022-11-03	Repair queued
0703-0076_SSN Memo_OPNAV 1770-2_5.10.2022.pdf	Supplementary Document	Uploaded 2022-11-03	Repair queued
0703-0076_SSA_11.28.2022.docx	Supporting Statement A	Uploaded 2022-11-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
238578	OPNAV 1770/3 Next of Kin Identification	Form	Modified	Next of Kin Identification
238578	OPNAV 1770/3 Next of Kin Identification	Form	Modified
238577	OPNAV 1770/2 Next of Kin Travel Request	Form	Modified	Next of Kin Travel Request
238577	OPNAV 1770/2 Next of Kin Travel Request	Form	Modified
238576	OPNAV 1770/1 Consent to Release Personal Information	Form	Modified	Consent to Release Personal Information
238576	OPNAV 1770/1 Consent to Release Personal Information	Form	Modified

ICR Details

OMB Control No: 0703-0076	ICR Reference No: 202210-0703-002
Status: Historical Active	Previous ICR Reference No: 201911-0703-003
Agency/Subagency: DOW/NAVY	Agency Tracking No: 0703-AALN
Title: Navy Casualty Assistance Forms
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/12/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/05/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2026	36 Months From Approved	01/31/2023
Responses	2,000	0	2,000
Time Burden (Hours)	1,300	0	1,300
Cost Burden (Dollars)	53,339	0	34,054

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Abstract: Provide Congressional offices with contact information for next of kin of deceased Sailors (upon consent); provide personal information to Defense Finance and Accounting Service (DFAS) for benefits payments; collect information to secure travel entitlements.

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Authorizing Statute(s): US Code: 38 USC 1965-1980 Name of Law: Service Members’ Group Life Insurance
   US Code: 10 USC 1475 Name of Law: Death Gratuity
   US Code: 10 USC 1447-1455 Name of Law: Survivor Benefit Plan
   US Code: 37 USC 452 Name of Law: Allowable travel and transportation: general authorities
  

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 37320	06/22/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 71591	11/28/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
OPNAV 1770/1 Consent to Release Personal Information	OPNAV 1770/1	Consent to Release Personal Information
OPNAV 1770/2 Next of Kin Travel Request	OPNAV 1770/2	Next of Kin Travel Request
OPNAV 1770/3 Next of Kin Identification	OPNAV 1770/3	Next of Kin Identification

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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	2,000	2,000	0	0	0	0
Annual Time Burden (Hours)	1,300	1,300	0	0	0	0
Annual Cost Burden (Dollars)	53,339	34,054	0	19,285	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $72,164

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: 12/05/2022

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