Exchange Identification and Privilege Card Application

Forms and Documents

Document Name	Status
Form Exchange Form 1100 Identification and Privilege Card Application Form	Modified
0702-0129_SSNJ Memo_2.1.2024.pdf Supplementary Document	2025-01-21
0702-0129_DraftPIA_1.10.2025.pdf Supplementary Document	2025-01-21
0702-0129_SSA_1.10.2025.docx Supporting Statement A	2025-01-21

IC Document Collections

IC ID	Document Title	Status
219006	Identification and Privilege Card Application Form	Modified

ICR Details

OMB Control No: 0702-0129	ICR Reference No: 202501-0702-003
Status: Received in OIRA	Previous ICR Reference No: 202112-0702-002
Agency/Subagency: DOD/DOA	Agency Tracking No:
Title: Exchange Identification and Privilege Card Application
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/21/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2025
Responses	220	207
Time Burden (Hours)	55	52
Cost Burden (Dollars)	399	375

---

Abstract: Dependents and Exchange Retirees wishing to obtain or maintain status as an Exchange authorized patron for shopping privileges submit applications for an approved patronage card.

---

Authorizing Statute(s): US Code: 10 USC 7013 Name of Law: Secretary of the Army
   US Code: 10 USC 8013 Name of Law: Secretary of the Air Force
   EO: EO 9397 Name/Subject of EO: SSN
  

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 63417	08/05/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 1980	01/10/2025
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Identification and Privilege Card Application	Exchange Form 1100-016	Identification and Privilege Card Application

---

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	220	207	0	13	0	0
Annual Time Burden (Hours)	55	52	0	3	0	0
Annual Cost Burden (Dollars)	399	375	0	24	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: Exchange Human Resource reporting was analyzed for the determination of cost for collection of information. There is a slight increase in annual responses, which has resulted in a small increase in total respondent burden.

---

Annual Cost to Federal Government: $49,326

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: 01/21/2025

---