Personnel Accountability & Assessment Notification for COVID-19

ICR 202004-0704-001

OMB: 0704-0590

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
0704-0590 202004-0704-001
Historical Active
DOD/DODDEP
Personnel Accountability & Assessment Notification for COVID-19
New collection (Request for a new OMB Control Number)   No
Emergency 04/03/2020
Approved with change 04/03/2020
Retrieve Notice of Action (NOA) 04/03/2020
This collection is approved for 6 months only. Should the Department want to use it for a longer time period, DOD must publish a 60 and 30 notice for public comment in the Federal Register.
  Inventory as of this Action Requested Previously Approved
10/31/2020 6 Months From Approved
100,000 0 0
8,333 0 0
60,000 0 0

The principal purpose of the DD form 3112, “Personnel Accountability and Assessment Notification for a Public Health Emergency,” is to collect information used to protect the health and safety of individuals working in, residing on, or assigned to DoD installations, facilities, field operations, and commands, and to protect the DoD mission.
In light of the current COVID-19 pandemic, the DoD has identified the need to collect and standardize information from members of the public who have been potentially exposed to COVID-19. There is an immediate need to collect this information to protect the health and safety of individuals working in, residing on, or assigned to DoD installations, facilities, field operations, and commands.

None
None

Not associated with rulemaking

No

1
IC Title Form No. Form Name
Personnel Accountability & Assessment Notification for COVID-19 DD Form 3112 Personnel Accountability & Assessment Notification for COVID-19

  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 100,000 0 0 100,000 0 0
Annual Time Burden (Hours) 8,333 0 0 8,333 0 0
Annual Cost Burden (Dollars) 60,000 0 0 60,000 0 0
Yes
Miscellaneous Actions
No
This is a new collection.

$1,020,500
No
    Yes
    Yes
No
No
No
Yes
Lane Purvis 571 372-0459 lane.m.purvis2.civ@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.
04/03/2020


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