Travis Air Force Base Exceptional Family Member Program (EFMP) Pilot Program Evaluation Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
DoDI 1315.19.pdf	Supplementary Document	Uploaded 2024-02-20	Repair queued
EFMP Survey Invite Letters_11.29.2023.docx	Supplementary Document	Uploaded 2024-01-23	Repair queued
0720-EFMP_SSB_2.20.2024.docx	Supporting Statement B	Uploaded 2024-02-20	Repair queued
0720-EFMP_SSA_3.11.2024.docx	Supporting Statement A	Uploaded 2024-03-11	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
264609	Exceptional Family Member Program(EFMP) Pilot Program Evaluation at Travis Air Force Base Survey	Other-Survey	New

ICR Details

OMB Control No: 0720-0075	ICR Reference No: 202401-0720-002
Status: Active	Previous ICR Reference No:
Agency/Subagency: DOW/DODOASHA	Agency Tracking No: 0720-EFMP
Title: Travis Air Force Base Exceptional Family Member Program (EFMP) Pilot Program Evaluation Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/17/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/12/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2027	36 Months From Approved
Responses	240	0	0
Time Burden (Hours)	80	0	0
Cost Burden (Dollars)	1,826	0	0

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Abstract: David Grant Medical Center is taking part in a pilot program for EFMP family members. The goal of this pilot program is to connect EFMP families with quality medical and non-medical resources to support and care for their family members. In this pilot program, EFMP family members at David Grant are being provided with “Care Maps” that identify resources tailored to their diagnoses. The intent of this web-based survey is to solicit feedback on the efficacy and usefulness of these resources, as well as feedback from EFMP families at David Grant that have not received specialized maps to understand their experience in obtaining EFMP care without said resources

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Authorizing Statute(s): US Code: 10 USC 1781c Name of Law: Office of Special Needs
  

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:
	88 FR 72439	10/20/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 17444	03/11/2024
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
Exceptional Family Member Program(EFMP) Pilot Program Evaluation at Travis Air Force Base Survey

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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	240	0	0	240	0	0
Annual Time Burden (Hours)	80	0	0	80	0	0
Annual Cost Burden (Dollars)	1,826	0	0	1,826	0	0

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new information collection with a new associated burden.

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Annual Cost to Federal Government: $509

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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.     No

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.     No

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: 03/12/2024

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