Request for Individual Access to Records Protected Under the Privacy Act; Consent for Disclosure of Records Protected Under the Privacy Act

Forms and Documents

Document Name	Status
Form DD Form 3214 CONSENT FOR DISCLOSURE OF RECORDS PROTECTED UNDER THE PRIVACY ACT Form and Instruction	New
Form DD Dorm 3213 REQUEST FOR INDIVIDUAL ACCESS TO RECORDS PROTECTED UNDER THE PRIVACY ACT Form and Instruction	New
0704-CASE_SSA_1.3.25.docx Supporting Statement A	2025-01-03

IC Document Collections

IC ID	Document Title	Status
272866	CONSENT FOR DISCLOSURE OF RECORDS PROTECTED UNDER THE PRIVACY ACT Form and Instruction	New
272863	REQUEST FOR INDIVIDUAL ACCESS TO RECORDS PROTECTED UNDER THE PRIVACY ACT Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202412-0704-004
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DOD/DODDEP	Agency Tracking No: 0704-CASE
Title: Request for Individual Access to Records Protected Under the Privacy Act; Consent for Disclosure of Records Protected Under the Privacy Act
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/03/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	30,000	0
Time Burden (Hours)	22,500	0
Cost Burden (Dollars)	686,250	0

---

Abstract: The CASES Act mandates the use of electronic access and consent forms, which can be submitted digitally. By allowing digital submissions, the Act aims to streamline the process, reduce delays, and enhance the efficiency of government services. DD Form 3213, “Request for Individual Access to Records Protected Under the Privacy Act,” and DD Form 3214, “Consent for Disclosure of Records Protected Under the Privacy Act,” is crucial for ensuring compliance with the CASES Act.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 76097	09/17/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 106452	12/30/2024
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
CONSENT FOR DISCLOSURE OF RECORDS PROTECTED UNDER THE PRIVACY ACT	DD Form 3214	CONSENT FOR DISCLOSURE OF RECORDS PROTECTED UNDER THE PRIVACY ACT
REQUEST FOR INDIVIDUAL ACCESS TO RECORDS PROTECTED UNDER THE PRIVACY ACT	DD Dorm 3213	REQUEST FOR INDIVIDUAL ACCESS TO RECORDS PROTECTED UNDER THE PRIVACY ACT

---

ICR Summary of Burden

	Total Request	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	30,000	0	0	30,000	0	0
Annual Time Burden (Hours)	22,500	0	0	22,500	0	0
Annual Cost Burden (Dollars)	686,250	0	0	686,250	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 collection associated with new burden.

---

Annual Cost to Federal Government: $3,414,000

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

---

Common Form ICR:  No

---

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: 01/03/2025

---