Exchange Accidents/Incidents Reports

ICR 201608-0702-002

OMB: 0702-0138

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Supporting Statement A
2016-08-11
Supplementary Document
2016-08-11
Supplementary Document
2016-08-11
Supplementary Document
2016-08-11
IC Document Collections
ICR Details
0702-0138 201608-0702-002
Historical Active
DOD/DOA
Exchange Accidents/Incidents Reports
Existing collection in use without an OMB Control Number   No
Regular
Approved without change 09/12/2016
Retrieve Notice of Action (NOA) 08/11/2016
DOD must report this collection in the Information Collection Budget.
  Inventory as of this Action Requested Previously Approved
09/30/2019 36 Months From Approved
4,854 0 0
4,854 0 0
35,192 0 0

Pursuant with Army Regulation 215-8/AFI 34-211(I) Chapter 13 and to adhere and resolve eligible patron issues and concerns, collection of information is required from the public to record incidents such as accidents, injuries, illnesses, mishaps, fires, theft or any issues involving government property. The recording of this information is necessary as a basis for payment of claims, providing medical treatment to those who are injured or ill, recovering damages on government property or assets, shoplifting and theft, and having supporting evidence in the event of legal actions.

US Code: 10 USC 8013 Name of Law: null
   EO: EO 12196 Name/Subject of EO: null
   US Code: 10 USC 3013 Name of Law: null
  
None

Not associated with rulemaking

  81 FR 31918 05/20/2016
81 FR 53128 08/11/2016
No

1
IC Title Form No. Form Name
Exchange Form 3900-017 "Statement" Exchange Form 3900-017 Statement

  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 4,854 0 0 0 0 4,854
Annual Time Burden (Hours) 4,854 0 0 0 0 4,854
Annual Cost Burden (Dollars) 35,192 0 0 0 0 35,192
No
No

$1,110,164
No
No
No
No
No
Uncollected
Tyler Robinson 571 372-0403 tyler.f.robinson.ctr@mail.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.
08/11/2016


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