Exchange Accidents/Incidents Reports

ICR 201909-0702-002

OMB: 0702-0138

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2019-09-26
Supplementary Document
2019-09-26
Supplementary Document
2019-09-26
Supplementary Document
2019-09-26
Supporting Statement A
2019-09-26
IC Document Collections
IC ID
Document
Title
Status
222957 Modified
ICR Details
0702-0138 201909-0702-002
Active 201608-0702-002
DOD/DOA
Exchange Accidents/Incidents Reports
Revision of a currently approved collection   No
Regular
Approved without change 10/29/2019
Retrieve Notice of Action (NOA) 09/26/2019
  Inventory as of this Action Requested Previously Approved
10/31/2022 36 Months From Approved 10/31/2019
209 0 4,854
209 0 4,854
1,515 0 35,192

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.

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

Not associated with rulemaking

  84 FR 22820 09/26/2019
84 FR 45473 08/29/2019
No

1
IC Title Form No. Form Name
AAFES 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 209 4,854 0 -4,645 0 0
Annual Time Burden (Hours) 209 4,854 0 -4,645 0 0
Annual Cost Burden (Dollars) 1,515 35,192 0 -33,677 0 0
No
Yes
Miscellaneous Actions
Burden reduced.

$95,314
No
    Yes
    Yes
No
No
No
Uncollected
Reginald Lucas 571 372-0403 reginald.t.lucas2.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.
09/26/2019


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