SUPPORTING STATEMENT - PART A
Certificate of Death Supplemental Information Worksheet – OMB Control Number 0720-COFD
1. Need for the Information Collection
The Certificate of Death Information Worksheet is a tool that will be utilized to gather information required to complete the DD Form 2064, “Certificate of Death,” if the necessary information is not available through normal channels. The DD Form 2064 is used by family members of deceased DoD employees, contractors, and non-affiliated civilians to settle estates, insurance claims, and other post-death related matters. The form is also used by the DoD to track the cause and manner of death of service members, federal employees, as well as their family members, dependents, and federal contractors, when a death occurs within federal jurisdiction or per Status of Forces Agreements. Foreign nations may or may not provide a death certificate; this form may be used in lieu of a foreign death certificate. The DD Form 2064 generates a death certificate that is accessible to next-of-kin. The form is also used by OCONUS hospitals and allows for the transportation of human remains. This collection of information is authorized by 10 USC 1471, “Forensic Pathology Investigations”; 10 USC 1509, “Program to Resolve Missing Persons Cases”; and DoD Instruction 5154.30, “Armed Forces Medical Examiner System (AFMES) Operations.”
2. Use of the Information
The Armed Forces Medical Examiner Tracking System (AFMETS) is a Government-developed system that provides medical examiners the ability to track and record autopsy and consultation information. Information is pushed from the Defense Casualty Information Processing System (DCIPS) in to AFMETS. If needed, additional information required to complete the DD Form 2064 may be collected using the Death Certificate Information Sheet. This Information sheet is provided via email to the service casualty office, law enforcement agency, contract company, or next-of-kin to collect the necessary information. Missing or relevant information required to complete the DD Form 2064 is transferred into AFMETS. No members of the public will provide information directly onto the DD Form 2064. To generate a DD Form 2064, the aggregate collected information contained within AFMETS is synthesized electronically to fill respective fields on the DD Form 2064. This form is signed by an appropriately credentialed health care provider. The DD2064 forms completed and signed by AFMES medical examiners are retained within AFMETS. Depending on circumstances, the completed DD Form 2064 is sent to the deceased’s next-of-kin, the designated funeral home, or the branch casualty office by Federal Express Certified Mail. If the deceased was a member of the U.S. military at the time of death, the DD Form 2064 may be downloaded by the service casualty offices who will print out copies to disseminate as required.
3. Use of Information Technology
Ninety-nine percent (99%) of the Death Certificate Information Sheets are returned by email.
4. Non-duplication
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
This information is collected on the occasion of the death of a DoD service member, Federal employee, or contractor OCONUS. If this information were collected less frequently the DoD would be unable to track cause/manner of death or provide a death certificate to next-of-kin which could prevent the settling of the deceased’s estate and insurance claims.
7. Paperwork Reduction Act Guidelines
To generate a DD Form 2064, the aggregate collected information is synthesized electronically to fill respective fields on the DD Form 2064. In some circumstances, the “race” designation may be unknown or be unable to verify or coded as “other.” The standard certificates represent the minimum basic data set necessary for the collection and publication of comparable national, state, and local vital statistics data. Authority to continue to use only the minimum categories for the collection of race and ethnicity data (Figure 3 from the 2024 SPD 15) is an operational necessity until such time as Human Resources Command and branch casualty offices updates DCIPS fields. Each U.S. state has its own bureau of vital records/statistics and the data are provided through vital registration systems maintained and operated by the individual states and territories where the original certificates are filed. The degree of uniformity necessary requires cooperative adoption of OMB standards by the individual registration areas. The standard certificate is a means to achieve uniformity in information on which statistics are based. A signed justification memo has been included with this information collection request.
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
Part A: PUBLIC NOTICE
A 60-Day Federal Register Notice (FRN) for the collection published on Friday, October 20, 2023. The 60-Day FRN citation is 88 FRN 72442.
No comments were received during the 60-Day Comment Period.
A 30-Day Federal Register Notice for the collection published on Thursday, October 10, 2024. The 30-Day FRN citation is 89 FRN 82583
Part B: CONSULTATION
The DD Form 2064 has been reviewed by the Central Joint Mortuary Affairs Board (CJMAB).
9. Gifts or Payment
No payments or gifts are being offered to respondents as an incentive to participate in the collection.
10. Confidentiality
A Privacy Act Statement is not required for this collection because we are not requesting individuals to furnish personal information for a system of records.
A system of record notice (SORN) is not necessary because, although the Department of Defense (DoD) Form 2064, “Certificate of Death (hereinafter “DD Form 2064”) will collect personally identifiable information (“PII”), the individual is a decedent. Deceased individuals do not have any Privacy Act rights, nor do executors or next-of-kin. Thus, a SORN is not required at this time.
A draft copy of the PIA, Armed Forces Medical Examiner System (AFMETS) Local Area Network MEDCOI, has been provided with this package for OMB’s review.
Records will be maintained in accordance with the following records disposition schedules:
Unscheduled - Permanent. Treat system and/or records maintained in the system as permanent until a NARA approved schedule and disposition authority has been applied. DHA is actively working with DHA Records Management & DoD Records on a SF115 Request for Records Disposition Authority.
11. Sensitive Questions
We are collecting demographic information on the form to include race which is vital for statistical purposes for public health initiatives and funding.
We are collecting Social Security Number on the form and have a signed SSN Justification Memo. This information is necessary in order to close out an individual’s Social Security account.
12. Respondent Burden and its Labor Costs
Part A: ESTIMATION OF RESPONDENT BURDEN
Death Certificate Information Sheet
Number of Respondents: 50
Number of Responses Per Respondent: 1
Number of Total Annual Responses: 50
Response Time: 1 hour
Respondent Burden Hours: 50 hours
Total Submission Burden
Total Number of Respondents: 50
Total Number of Annual Responses: 50
Total Respondent Burden Hours: 50 hours
Part B: LABOR COST OF RESPONDENT BURDEN
Death Certificate Information Sheet
Number of Total Annual Responses: 50
Response Time: 1 hour
Respondent Hourly Wage: $7.25
Labor Burden per Response: $7.25
Total Labor Burden: $362.50
Overall Labor Burden
Total Number of Annual Responses: 50
Total Labor Burden: $363
The wages of respondents for the instruments vary greatly, we used Federal minimum wage to estimate labor costs (https://www.usa.gov/minimum-wage).
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
Death Certificate Information Sheet
Number of Total Annual Responses: 50
Processing Time per Response: 1 hour
Hourly Wage of Worker(s) Processing Responses: $41.63
Cost to Process Each Response: $41.63
Total Cost to Process Responses: $2,081.50
Overall Labor Burden to the Federal Government
Total Number of Annual Responses: 50
Total Labor Burden: $2,081.50
Part B: OPERATIONAL AND MAINTENANCE COSTS
Cost Categories
Equipment: $0
Printing: $100
Postage: $850
Software Purchases: $0
Licensing Costs: $0
Other: $0
Total Operational and Maintenance Cost: $950.00
Part C: TOTAL COST TO THE FEDERAL GOVERNMENT
Total Labor Cost to the Federal Government: $2,081.50
Total Operational and Maintenance Costs: $950.00
Total Cost to the Federal Government: $3,031.50
15. Reasons for Change in Burden
This is an existing collection currently in use without an OMB Control Number.
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 |