Collection of Required Data Elements to Verify Eligibility

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Not Impacted Letter.docx	Supplementary Document	Uploaded 2026-01-20	Repair queued
Impacted-BI no prints Letter.docx	Supplementary Document	Uploaded 2026-02-12	Available
Impacted-BI prints Letter.docx	Supplementary Document	Uploaded 2026-02-12	Available
Impacted-BI no prints Letter.docx	Supplementary Document	Uploaded 2026-01-20	Available
Impacted-PR BI prints Letter.docx	Supplementary Document	Uploaded 2026-01-20	Available
Impacted-PR Only Letter.docx	Supplementary Document	Uploaded 2026-01-20	Repair queued
OATSDPCLT_PSBNMR_SSNJ Decision Memo_Signed.pdf	Supplementary Document	Uploaded 2022-09-28	Repair queued
PIA_DMDC_20_OPM-V_Sec1.pdf	Supplementary Document	Uploaded 2026-01-20	Available
0704-0545_SSA_2.26.26.docx	Supporting Statement A	Uploaded 2026-02-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218567	Collection of Required Data Elements to Verify Eligibility	Other-Screenshots	Unchanged

ICR Details

OMB Control No: 0704-0545	ICR Reference No: 202601-0704-006
Status: Active	Previous ICR Reference No: 202205-0704-002
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Collection of Required Data Elements to Verify Eligibility
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/08/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/26/2026
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2029	36 Months From Approved	04/30/2026
Responses	50,000	0	50,000
Time Burden (Hours)	4,000	0	4,000
Cost Burden (Dollars)	156,000	0	156,000

---

Abstract: This is a request for extension for a collection of information necessitated by the Office of Personnel Management (OPM) cybersecurity incident in which approximately 21.5 million security clearance background investigation records containing personally identifying information (PII) were compromised. The information collected will be used only to verify whether or not an individual was impacted by the OPM cybersecurity incident involving background investigation records and to send a letter confirming status as “impacted” or “not impacted” by this incident.

---

Authorizing Statute(s): EO: EO 12333 Name/Subject of EO: United States Intelligence Activities
   EO: EO 13402 Name/Subject of EO: Strengthening Federal Efforts to Protect Against Identity Theft
   US Code: 10 USC 113 Name of Law: Secretary of Defense
   EO: EO 13526 Name/Subject of EO: Classified National Security Information
   US Code: 50 USC 3038 Name of Law: Responsibilities of Secretary of Defense Pertaining to National Intelligence Program
  

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:
	90 FR 61383	12/31/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 9243	02/25/2026
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Collection of Required Data Elements to Verify Eligibility

---

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	50,000	50,000	0	0	0	0
Annual Time Burden (Hours)	4,000	4,000	0	0	0	0
Annual Cost Burden (Dollars)	156,000	156,000	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $546,727

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: 02/26/2026

---