Supporting Statement A

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SUPPORTING STATEMENT
Forms Relating to Military Service Records
(NA Forms 13036, 13042, 13055, 13075 and 13177)
OMB Control No. 3095-0039
1. Circumstances making it necessary to collect the information. The National Personnel
Records Center (NPRC) of the National Archives and Records Administration (NARA)
administers military personnel and medical records of veterans after discharge, retirement,
and death. Personnel records of military members who were discharged, retired, or died in
service 62 or more years ago have been transferred to the legal custody of NARA and are
referred to as “archival” records. Personnel records of military members who were
discharged, retired, or died in service less than 62 years ago remain in the legal custody of the
creating service and are administered in accordance with rules issued by the Department of
Defense (DOD) and the Department of Homeland Security (DHS, U.S. Coast Guard). These
records are hereafter referred to as “non-archival” records. In addition, NPRC administers the
medical records of dependents of service personnel. When veterans, dependents, and other
authorized individuals request information from or copies of documents in military personnel,
military medical, and dependent medical records, they must provide on forms, in letters, or
online certain information about the veteran and the nature of the request. Federal agencies,
military departments, veterans, veteran’s organizations, and the general public use Standard
Forms (SF) 180, Request Pertaining to Military Records, in order to obtain information from
military personnel service records stored at NPRC. Veterans or their next-of-kin also may
submit requests online using eVetRecs. The authority for this information collection is
contained in 36 CFR 1233.18.
A major fire at the NPRC on July 12, 1973, destroyed numerous military records. If
individuals’ requests involve records or information from records that may have been lost in
the fire, requesters may be asked to complete NA Form 13075, Questionnaire about Military
Service, or NA Form 13055, Request for Information Needed to Reconstruct Medical Data, so
that NPRC staff can search alternative sources to reconstruct the requested information.
Requesters who ask for medical records of dependents of service personnel and
hospitalization records of military personnel may be asked to complete NA Form 13042,
Request for Information Needed to Locate Medical Records, so that NPRC staff can locate the
desired records.
Certain types of information contained in military personnel and medical records are
restricted from disclosure unless the veteran provides a more specific release authorization
than is normally required. Veterans are asked to complete NA Form 13036, Authorization for
Release of Military Medical Patient Records, to authorize release to a third party of a
restricted type of information found in the desired record.
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Requesters have the ability to check the status of a request for clinical and/or medical
treatment records through the online NA Form 13177, Check the Status of a Clinical &
Medical & Treatment Records Request. Information collected is used to identify requests at
the NPRC.
2. Purpose and use of the information. Although military non-archival personnel and
medical records described above are in NPRC’s physical custody, legal custody of the records
remains with the Department of Defense, the Department of Homeland Security, or the
creating agency. Handling of requests for information from the records must conform to the
legal requirements of the Freedom of Information Act (FOIA), the Privacy Act, and the
implementing regulations of DOD and DHS, Coast Guard. NPRC uses information submitted
on NA Forms 13036, 13042, 13055, and 13075 in order to locate requested records and to
determine the releasability of records under DOD/DHS, Coast Guard rules. When third
parties submit requests, this information collection serves as a record of disclosure since
military non-archival service records are covered by the Privacy Act. Without the
information collection, NPRC would be unable to provide requested information to requesters
since information submitted in the information collection is the minimum NPRC staff need in
order to locate and release requested records.
3. Use of information technology and burden reduction. NPRC has made NA Forms 13036,
13042, 13055, 13075 and 13177 available online at the locations listed below. At this time,
however, no information technology application is available to accept the collected
information online. The collected information is the minimum information needed to allow
NPRC to locate the record and provide the requested information. Also, minimum usage of
any one form makes compliance with Government Paperwork Elimination Act (GPEA)
requirements unfeasible.
Web addresses:
(13036) http://www.archives.gov/st-louis/military-personnel/public/medical-records-veteransaccess.html
(13042) http://www.archives.gov/st-louis/military-personnel/na-13042-request-4-informationneeded-2-locate-medical-records.pdf
(13055) http://www.archives.gov/st-louis/military-personnel/na-13055-info-2-reconstructmedical-data.pdf
(13075) http://www.archives.gov/st-louis/military-personnel/na-13075-questionnaire-aboutmilitary-service.pdf
(13177) https://www.archives.gov/forms/st-louis/clinical-followup.html
4. Efforts to identify duplication and use of similar information. There is no duplication.
5. Impact on small businesses or other small entities. NPRC has minimized the burden on
small businesses and other small entities by accepting requests directly from individuals who
are verifying their military service for employment with small businesses/entities or for other
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purposes. NPRC also accepts requests from small businesses/small entities in the format of
the requester's choosing.
6. Consequences of collecting the information less frequently. The frequency of response is
on occasion, such as when individuals, businesses, and government agencies desire to acquire
information from military personnel and medical records. Therefore, the information
collection cannot be conducted less frequently because requesters determine when they want
to request information. Many requesters submit one request in order to obtain replacements
of documents in military service files or to verify some aspects of an individual's military
service. Some requesters who conduct genealogical research may submit multiple requests,
although NPRC has estimated that such individuals comprise no more than 3% of the total
number of requesters.
7. Special circumstances relating to the guidelines of 5 CFR 1320.5. This information
collection will be conducted in a manner consistent with 5 CFR 1320.5.
8. Comments in response to the Federal Register notice and efforts to consult outside
agency. No formal consultations have taken place. NARA published a notice in the Federal
Register on March 20, 2023 (88 FR 16670) requesting public comment. No comments were
received. A second notice will be published in the Federal Register when this information
collection is submitted to OMB for clearance.
9. Explanation of any payment or gift to respondents. This information collection involves
no remuneration to respondents.
10. Assurance of confidentiality provided to respondents. NPRC staff retains, in military
personnel and medical files, in dependent medical files, and in NPRC’s Case Management
and Reporting System (CMRS) NA Forms 13036, 13042, 13055, and 13075 as Privacy
Act-protected records of disclosure. NA Forms 13036, 13042, 13055, and 13075 become
releasable only in accordance with Privacy Act provisions, contained in 5 U.S.C. 552a, and
the routine uses for systems of military personnel records, contained in the Privacy Act
system notice (SORN 35) published in the Federal Register at 78 FR 245 (December 20,
2013). Information collected on the online NA Form 13177 is not retained as it is only used
as a reference to identify request information.
11. Justification for sensitive questions. Respondents are asked no questions of a sensitive
nature.
12. Estimates of hour burden including annualized hourly costs. The hour burden for all
individual respondents is as follows:

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Form of Request
from Respondents

Number of
Respondents

Responses per
Respondent

Minutes per
Response

Annual Hour
Burden

NA Form 13036

1,300

1

5

108

NA Form 13042

8,500

1

5

708

NA Form 13055

10,000

1

5

834

NA Form 13075

30,000

1

5

2,500

NA Form 13177

30,000

1

5

2,500

TOTAL

79,800

--

--

6,650

NPRC developed the respondent data by observing the percentage of forms sent by NPRC
for requesters to complete and return. The estimated times for each form of inquiry are
based on the expectation that most respondents will be veterans/dependents who can
complete required information from memory. Even the next of kin or others acting on
authority of veterans/dependents are usually prepared to complete the essential information
just as quickly. NPRC has found that most respondents leave blank those entries on forms
for which the information is not readily known rather than research the information. NPRC
staff has made such observations of visitors to NPRC who are considered to be typical of
individuals who submit their requests by mail.
13. Estimate of other total annual cost burden to respondents or recordkeepers. The
estimated annualized cost for individual respondents is $1.10 with the exception of NA
Form 13177 which is $0.60. The total estimated annualized respondent cost is $119,951.
These costs are based on NPRC’s estimate that respondents who submit the NA Forms
13036, 13042, 13055, 13075 and 13171 will take 5 minutes to complete a form. Because
requests are normally made for the personal benefit of requesters, the cost of a respondent’s
time is established at the minimum wage rate of $7.25 per hour. The remainder of each
respondent cost consists of costs for envelopes ($.01) and postage ($.49).
Form of
Request from
Respondents

Number of
Respondents

Minutes per
Response

Respondent
Cost

Annualized Cost
for Hour Burden

NA Form 13036

1,300

5

$1.10

$1,435

NA Form 13042

8,500

5

$9,350

NA Form 13055

10,000

5

$1.10
$1.10

$11,000

NA Form 13075

30,000

5

$1.10

$33,000

NA Form 13177

30,000

$0.60

$33,000

TOTAL

79,800

5
--

$1.10

$87,785

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14. Annualized cost to the Federal government. The total estimated annualized cost to
NARA is $3,989. This cost consists of the estimated annualized costs for desktop printing
of NA Forms 13036, 13042, 13055, 13075 and 13177. However, no cost is assigned to the
staff time required to perform core functions at NPRC, including: responding to letter and
forms requests that contain sufficient information; and reviewing and preparing the
responses for mailing.
15. Explanation for program changes or adjustments. There is no change. The previous
submission had an error showing 500 respondents for NA Form 13177; those extra 500
respondents have been removed for this submission.
16. Plans for tabulation and publication and project time schedule. The information
collection is not used for statistical studies or publications.
17. Reason(s) display of OMB expiration date is inappropriate. The expiration date of the
OMB approval will be displayed on the forms.
18. Exceptions to certification for Paperwork Reduction Act submissions. NARA is not
requesting any exceptions to the certification statement identified in Item 19, “Certification
for Paperwork Reduction Submissions,” of OMB Form 83-I.

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