SUPPORTING STATEMENT - PART A
EXCEPTIONAL FAMILY MEMBER PROGRAM - OMB Control Number 0704-0411
Summary of Changes from Previously Approved Collection
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1. Need for the Information Collection
The Individuals with Disabilities Education Act, (Sections 1400 et seq. of title 20, United States Code) and the Defense Dependents Education Act, (Sections 921 et seq. of title 20, United States Code) require the Department of Defense to provide early intervention services to developmentally delayed infants and toddlers (birth through 2) and special education and medically related services to children with disabilities from 3 through 21 years of age who are eligible to attend a DoD school. To ensure the availability of necessary medical and educational services for family members, the Department must identify those who have special health or educational needs. Medical and educational needs are also considered when approving family travel to a Continental United States (CONUS) , overseas or remote location where DoD must provide the services.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 (Public Law 94-191) requires specific language to advise the individuals that personally identifiable health information shall not be used or disclosed except for specifically permitted purposes, unless informed consent is provided by the individual. The Department is standardizing the information collection to ensure that appropriate information is collected and that it meets the data collection HIPAA requirements.
The National Defense Authorization Act (NDAA) for Fiscal Year 2010 (Public Law 111-84) requires procedures to identify members of the Uniformed Services who are members of military families with special needs, mechanisms to ensure their timely and accurate evaluations and enrollment.
2. Use of the Information
The purpose of this information collection is to 1) enroll sponsors into the Exceptional Family Member Program (EFMP), 2) match the special needs of family members against the availability of medical and educational services through the Family Member Travel Screening (FMTS) process, and 3) advise civilian employees about the availability of medical and educational services to meet the special needs of their family members. Respondents are Military members and DoD civilian employees, private physicians and school personnel. Respondents may access these information collection instruments online, or through paper copies provided to them. Similarly, the information collection instruments may be completed either by hand or digitally and returned via secure digital exchange or in-person using a paper copy of the information collection instruments.
This information collection is primarily used by the Uniformed Services to enroll family members who meet the criteria for special medical and educational needs into the EFMP as well as identifying individuals requiring special consideration when authorizing family travel to an overseas or remote location at government expense. The DD Form 2792, “Family Member Medical Summary,” and DD Form 2792-1, “Special Education/Early Intervention Summary,” are the forms associated with this information collection.
The sponsor or family member completes the demographics section on both collections, a qualified medical provider completes the medical summary on the DD 2792, and the special education or early intervention staff completes the early intervention/special education summary of the DD 2792-1. On the DD2792, the sponsor or family member provides authorization for disclosure of the medical information and certifies the accuracy of the information. On the DD 2792-1, the sponsor or family member authorizes the release of information. The information is provided to EFMP medical personnel for enrollment in the program, and both medical and educational screening personnel in overseas and remote locations for their determination of the availability of medical and education resources necessary to meet the family member’s needs. The medical and/or educational recommendation is supplied to the appropriate Military Department’s personnel department in determining the future assignment for the service member.
This information collection may also be used to identify available medical and educational resources to DoD civilian employees who are considering a job overseas to assist them in deciding whether to relocate overseas with a family member who has special medical or educational needs. The information is not supplied to agencies outside of the Department of Defense. Respondents are required to update the forms every 3 years, and communication from the Military Departments may be sent to the respondent requesting an update to the information collection.
3. Use of Information Technology
The DD Form 2792 and DD Form 2792-1 are available to the public electronically online from the Department of Defense forms website (https://www.esd.whs.mil/Directives/forms/dd2500_2999/). The current electronic response rate is 30%. For respondents who have access to computerized information technology, the forms can be completed online and electronically signed using a Common Access Card (CAC). This is due to the number of individuals (civilian physician and/or public-school officials) required to complete the forms. Notably, majority of military-connected children attend public schools.
The Department is in the process of developing a standard information technology (IT) system that may be able to increase the percentage of responses collected electronically. Please note that non-DoD respondents (civilian medical providers & civilian public education staff) will not be able to access the DoD IT system.
4. Non-duplication
Investigation resulted in no findings of duplicate records. 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
After initial enrollment, respondents are required to update the forms every 3 years. If this information is not collected it will be impossible for the Military Departments to consider the special medical and/or educational needs of family members when determining assignments, nor would it be possible to inform civilian employees of the availability of services overseas. If the information is collected less often, it may result in an incorrect decision about assignment and thus a lack of adequate resources to meet the family member’s medical and/or educational needs. In addition, the Department would incur significant costs if family members were returned to the United States from an overseas location due to non-existent or insufficient medical support being available.
7. Paperwork Reduction Act 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).
8. Consultation and Public Comments
A 60-Day Federal Register Notice (FRN) for the collection published on (Monday, May 15, 2023). The 60-Day FRN citation is 88 FRN 30951-30952.
One comment was received during the 60-Day Comment Period. It is included below in the order received, as well as our Agency’s response to the comment.
The Commissioned Corps of US Public Health Service(USPHS) and the National Oceanic and Atmospheric Administration (NOAA) are two of the eight uniformed services of the United States. I would like to comment to add USPHS and NOAA to the following forms:
Link to form 2792 - Block 3d does not include USPHS or NOAA
Form 2792-1 - Block 2g does not include USPHS or NOAA
The EFMP is for covered members of the armed forces. The term “armed forces” means the Army, Navy, Air Force, Marine Corps, Space Force, and Coast Guard. The branches of Service block on the DD Form 2792 and DD Form 2792-1 aligns to the definition as outlined in U.S. Code Title 10. Therefore, the Department did not add the NOAA or USPHS because the suggested revision does not align with legislation.
A 30-Day Federal Register Notice for the collection published on Tuesday, September 19, 2023. The 30-Day FRN citation is 88 FRN 64418.
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
A PAS is located at the top of DD2782 and DD2792-1.
SORNs are maintained by each of the Services. The DoD Blanket Routine Uses found at (https://dpcld.defense.gov/Privacy/SORNsIndex/Blanket-Routine-Uses/)apply to this collection.
Applicable SORNs:
Army
A0600-8-104b AHRC, Official Military Personnel Record (https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570054/a0600-8-104-ahrc/)
A0608b CFSC, Personnel Affairs: Army Community Service Assistance Files (https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570084/a0608b-cfsc)
Marine Corps
M01070-6, Marine Corps Official Military Personnel Files (https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570626/m01070-6/)
M01754-6 - Exceptional Family Member Program Records (https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570631/m01754-6/)
Navy
N01070-3, Navy Military Personnel Records System (https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570310/n01070-3/)
N01301-2, On-Line Distribution Information System (ODIS) (https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570320/n01301-2/)
Air Force
F036 AF PC C, Military Personnel Records System (https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/569824/f036-af-pc-c/)
F044 AF SG U, Special Needs and Educational and Developmental Intervention
Services
(https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/569875/f044-af-sg-u/)
DoD
EDHA 07, Military Health Information System
(https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570672/edha-07/)
Department of Defense Education Activity
DoDEA 26, Department of Defense Education Activity Dependent Children's School Program Files
(https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570573/dodea-26/)
DoDEA 29, DoDEA Non-DoD Schools Program
(https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570576/dodea-29/)
A Privacy Impact Assessment (PIA) is not required for this collection because PII is not being collected electronically.
Records Retention and Disposition Schedules:
Army
A0600-8-104b AHRC, Official Military Personnel Record: Soldiers records are offered to the National Archives 75 after years individual's final separation. The National Archives, after consultation with the Department of the Army, genealogists, historians, social scientists, and other interested parties, will then determine the disposition of the records based on any continuing administrative needs and their archival value. Records, if any, not selected for permanent retention by the Archives will be disposed of.
A0608b CFSC, Personnel Affairs: Army Community Service Assistance Files: Destroyed after 2 years. Information may be transferred from one Army Community Service Center to another upon permanent change of station of service member.
Marine Corps
M01070-6, Marine Corps Official Military Personnel Files: Official Military Personnel File records are permanent. Records of Marines who separated, retired, or whose military service obligation expired prior to 1 January 1998 are maintained at the National Personnel Records Center, 9700 Page Avenue, St Louis MO 63132-5100. The records of Marines with remaining military service obligation or contractual obligations after 31 December 1997 are maintained at Headquarters, U.S. Marine Corps, U.S. Marine Corps (Code MMSB), 2008 Elliot Road, Quantico, VA 22134-5030. Permanent records are transferred to the National Archives and Records Administration (NARA) 62 years after the completion of the service member's obligated service. For Official Military Personnel File records of Marine Corps members in the regular or reserve components as of 1 January 1998 or those members who separated, retired, or died while in service, in the year 1998 or later are maintained at the National Personnel Records Center, Military Personnel Records Branch, 9700 Page Avenue, St. Louis, MO 63132-5100.
M01754-6 - Exceptional Family Member Program Records: The records retention has not been approved by the National Archives and Records Administration, until then treat as permanent.
Navy
N01070-3, Navy Military Personnel Records System: Those documents that are designated as temporary in the prescribing regulations remain in the record until their obsolescence, or the member is separated from the Navy, then are removed and provided to the individual. Those documents designated as permanent are submitted to Navy Personnel Command at predetermined times to form a single personnel record in the Electronic Military Personnel Records System (EMPRS), and remain in EMPRS permanently. Permanent records are transferred to the National Archives and Records Administration 62 years after the completion of the service member's obligated service.
N01301-2, On-Line Distribution Information System (ODIS): Destroy 1 month after release from active duty, when superseded or when no longer needed for reference, whichever is earliest. Paper records are disposed of by burning or shredding. Electronic records are deleted from encrypted hard drives.
Air Force
F036 AF PC C, Military Personnel Records System: Records are retained 3 months after reporting, and then destroyed by tearing into small bits, pulping, shredding, burning, or macerating.
F044 AF SG U, Special Needs and Educational and Developmental Intervention Services: A Special Needs Assignment Coordination Record is closed when criteria for the Q-Code identifier no longer is met, or the AD member separates or retires from military services. An Educational and Developmental Intervention Services, early intervention services record is closed when the child, 0-3 years old, has reached and maintained age appropriate skills and is determined to no longer require services. A related services record is closed when the school age child no longer requires services, passes the age criteria, transfers to a public education system. Cut off and transfer to the National Personnel Records Center, 9700 Page Blvd, St Louis, MO 63132-1547, 2-years after the end of the calendar year in which the Q-code deletion request has been affirmed by AFPC where they are destroyed after 25 years.
DoD
DHRA 23 DoD, Defense Civilian Human Resource Management System (DCHRMS): DCHRMS records are retained for 25 years after an individual separates from the government and then the records are purged; Corporate Management Information System records are cutoff and destroyed when no longer needed for business use.
EDHA 16 DoD, Special Needs Program Management Information System (SNPMIS) Records: Records are maintained until no longer needed for current business.
EDHA 07, Military Health Information System: Disposition pending (treat records as permanent until the National Archives and Records Administration have approved the retention and disposition schedule).
OSD/JS, DMDC 02 Defense Enrollment Eligibility Reporting Systems (DEERS): Records are maintained until no longer needed for current business.
Department of Defense Education Activity
DoDEA 26, Department of Defense Education Activity Dependent Children's School Program Files: Documents and electronic records on enrollment and registration, school registration forms, parental correspondence, other notes and related information and similar records are destroyed five (5) years after transfer, withdrawal, or death of student. Tutor record files are destroyed six (6) years and three (3) months after period covered by account. Records of students not approved for the program are destroyed one year after end of school year.
DoDEA 29, DoDEA Non-DoD Schools Program: Documents and electronic records on enrollment and registration, school registration forms, parental correspondence, other notes and related information and similar records are destroyed five (5) years after transfer, withdrawal, or death of student. Tutor record files are destroyed six (6) years and three (3) months after period covered by account. Records of students not approved for the program are destroyed one year after end of school year.
11. Sensitive Questions
All the information on DD Form 2792 and DD Form 2792-1 is considered sensitive. The forms collect information about family members and their medical or educational disabilities and are used to help match the needs of family members with the locations where their special needs can be met. Complete information increases the likelihood that the recommendation will accurately reflect the needs. The purpose of the form, however, requires that such information be collected so that the medical and educational needs can be met overseas and CONUS.
12. Respondent Burden and its Labor Costs
Part A: ESTIMATION OF RESPONDENT BURDEN
Collection Instrument(s)
[DD Form 2792 “Family Member Medical Summary”]
Respondents: Family Members
Number of Respondents: 55,828 Family Members
Number of Responses Per Respondent: 1
Number of Total Annual Responses: 55,828 Family members
Response Time: 5 minutes
Respondent Burden Hours: 4,652 hours
[DD Form 2792 “Family Medical Summary”]
Respondents: Medical Providers
Number of Respondents: 11,166
Number of Responses Per Respondent: 1
Number of Total Annual Responses: 11,166
Response Time: 25 minutes
Respondent Burden Hours: 4,653 hours
[DD Form 2792-1 “Special Education / Early Intervention Summary”]
Respondents: Family Members
Number of Respondents: 16,906
Number of Responses Per Respondent: 1
Number of Total Annual Responses: 16,906
Response Time: 5 minutes
Respondent Burden Hours: 1,409 hours
[DD 2792-1 “Special Education / Early Intervention Summary”]
Respondents: Special Education Members
Number of Respondents: 14,708
Number of Responses Per Respondent: 1
Number of Total Annual Responses: 14,708
Response Time: 20 minutes
Respondent Burden Hours: 4,903 hours
Total Submission Burden
Total Number of Respondents: 98,608
Total Number of Annual Responses: 98,608
Total Respondent Burden Hours: 15,617 hours
Part B: LABOR COST OF RESPONDENT BURDEN
DD Form 2792 “Family Member Medical Summary”
Respondent: Family Member
Number of Total Annual Responses: 55,828 Family Members
Response Time: 5 minutes
Respondent Hourly Wage: $29.76
Labor Burden per Response : $2.48
Total Labor Burden: $132,915.30
[DD Form 2792 “Family Member Medical Summary”]
Respondents: Medical Providers
Number of Total Annual Responses: 11,166
Response Time: 25 minutes
Respondent Hourly Wage: $107.91
Labor Burden per Response: $44.96
Total Labor Burden: $506,068
[DD Form 2792-1 “Special Education / Early Intervention Summary”]
Respondents: Family Members
Number of Total Annual Responses: 16,906
Response Time: Response Time: 5 minutes
Respondent Hourly Wage: $29.76
Labor Burden per Response: $2.48
Total Labor Burden: $40,249.80
[DD Form 2792-1 “Special Education / Early Intervention Summary]
Respondents: Special Education Teachers
Number of Total Annual Responses: 14,708
Response Time: 20 minutes
Respondent Hourly Wage: $46.44
Labor Burden per Response: $15.33
Total Labor Burden: $225,403.04
Overall Labor Burden
Total Number of Annual Responses: 98, 608
Total Labor Burden: $904,636.14
Please see below for an explanation of how burden was estimated.
The Respondent hourly wage was determined by using the Bureau of Labor Statistics Website (https://www.bls.gov/bls/blswage.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
DD Form 2792 “Family Member Medical Summary”
Number of Total Annual Responses: 55,828
Processing Time per Response: 40 minutes
Hourly Wage of Worker(s) Processing Responses : $19.59
Cost to Process Each Response: $13.06
Total Cost to Process Responses: $729,113.68
DD Form 2792-1 “Special Education / Early Intervention Summary”
Number of Total Annual Responses: 16,906
Processing Time per Response: 40 minutes
Hourly Wage of Worker(s) Processing Responses : $19.59
Cost to Process Each Response: $13.06
Total Cost to Process Responses: $220,792.36
Overall Labor Burden to the Federal Government
Total Number of Annual Responses: 72,734
Total Labor Burden: $949,906.04
Part B: OPERATIONAL AND MAINTENANCE COSTS
Cost Categories
Equipment: $0
Printing: $64,654.46
Postage: $0
Software Purchases: $0
Licensing Costs: $0
Other: $0
Total Operational and Maintenance Cost: $64,654.46
Part C: TOTAL COST TO THE FEDERAL GOVERNMENT
Total Labor Cost to the Federal Government: $949,906.04
Total Operational and Maintenance Costs: $64,656.46
Total Cost to the Federal Government: $1,014,562.50
15. Reasons for Change in Burden
The burden has increased since the previous approval due to the increases to the hourly wage for the respondents.
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 Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Kaitlin Chiarelli |
| File Modified | 0000-00-00 |
| File Created | 2023-09-20 |