Domestic Abuse Victim Reporting Option Statement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DD Form 2967 Domestic Abuse Victim Reporting Option Statement	Form and Instruction	New	Available
Form DD Form 2967 Domestic Abuse Victim Reporting Option Statement	Form and Instruction	New	Repair queued
DoDM 7730.47-M, Volume 1 7DEC2010.pdf	Supplementary Document	Uploaded 2023-04-25	Repair queued
PIA_AF_12-16-22.pdf	Supplementary Document	Uploaded 2023-04-19	Repair queued
PIA_Navy_CNIC_FFSMIS_9-4-2014.pdf	Supplementary Document	Uploaded 2023-04-19	Repair queued
PIA_Army_draft_9 Feb 21.pdf	Supplementary Document	Uploaded 2023-04-19	Repair queued
0704-DARS_SSA_DARS_5.10.2023.docx	Supporting Statement A	Uploaded 2023-05-10	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
259324	Domestic Abuse Victim Reporting Option Statement	Form and Instruction	New	Domestic Abuse Victim Reporting Option Statement
259324	Domestic Abuse Victim Reporting Option Statement	Form and Instruction	New

ICR Details

OMB Control No: 0704-0666	ICR Reference No: 202302-0704-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOW/DODDEP	Agency Tracking No: 0704-DARS
Title: Domestic Abuse Victim Reporting Option Statement
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: 06/14/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/12/2023
Terms of Clearance: This collection should be reported by the Department in DOD's submission to the Information Collection Budget.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2026	36 Months From Approved
Responses	20,000	0	0
Time Burden (Hours)	25,000	0	0
Cost Burden (Dollars)	708,800	0	0

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Abstract: The information collected will be used for purposes of filing an official report for a victim of domestic abuse. When a restricted report is filed, the victim is able to receive advocacy and counseling services without a report being made to command or law enforcement. In cases of an unrestricted report, command and law enforcement will be notified, and the victim is eligible to receive advocacy and counseling services from the Family Advocacy Program. The information collected for the form in unrestricted report cases may be used to initiate an investigation, and subsequently make an incident status determination following the Incident Determination Committee procedures and processes outlined in DoD Manual 6400.01, Volume 3. If an incident meets the definitions outlined in DoDM 6400.01, Volume 3, the incident is subject to entry into the Central Registry (DoDM 6400.01, Volume 2).

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Authorizing Statute(s): None

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 66681	11/04/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 30098	05/10/2023
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
Domestic Abuse Victim Reporting Option Statement	DD Form 2967	Domestic Abuse Victim Reporting Option Statement

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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	20,000	0	0	20,000	0	0
Annual Time Burden (Hours)	25,000	0	0	25,000	0	0
Annual Cost Burden (Dollars)	708,800	0	0	708,800	0	0

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: Burden increased due to an an existing collection currently in use without an OMB Control Number.

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Annual Cost to Federal Government: $1,894,800

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: 05/12/2023

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