Application for a Review by the Physical Disability Board of Review

ICR 201212-0704-006

OMB: 0704-0453

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
0704-0453 201212-0704-006
Historical Active 201003-0704-014
DOD/DODDEP
Application for a Review by the Physical Disability Board of Review
Reinstatement with change of a previously approved collection   No
Regular
Approved with change 03/08/2013
Retrieve Notice of Action (NOA) 12/11/2012
This collection is approved based on the revised materials provided by the Department.
  Inventory as of this Action Requested Previously Approved
03/31/2016 36 Months From Approved
1,800 0 0
1,350 0 0
0 0 0

Former members of the Armed Forces who were separated form the Armed Forces during the period beginning on September 11, 2001 and ending on December 31, 2009 due to unfitness for duty due to a medical condition with a disability rating of 20 percent disabled or less and were found to be not eligible for retirement may request a review of the decision. Agency will use information obtained to review the decision in accordance with the requirements in 10 USC 1554(a) for fairness and accuracy.

US Code: 10 USC 1554(a) Name of Law: null
  
US Code: 10 USC 1554(a) Name of Law: null

Not associated with rulemaking

  76 FR 12082 03/04/2011
77 FR 12082 11/23/2012
No

1
IC Title Form No. Form Name
Application for a Review by the Physical Disability Board of Review DD Form 294 Application for a Review by the Physical Disability Board of Review

  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 1,800 0 0 0 950 850
Annual Time Burden (Hours) 1,350 0 0 0 712 638
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Increase in number of respondents.

$216,400
No
No
No
No
No
Uncollected
Patricia Toppings 703 696-5284 PLToppings@whs.mil

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/11/2012


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