Application for Surrogate Association for DoD Self-Service (DS) Logon

ICR 202106-0704-013

OMB: 0704-0559

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2021-06-29
Supplementary Document
2021-06-29
Supporting Statement A
2021-09-20
Supplementary Document
2021-07-23
IC Document Collections
ICR Details
0704-0559 202106-0704-013
Received in OIRA 201807-0704-005
DOD/DODDEP
Application for Surrogate Association for DoD Self-Service (DS) Logon
Revision of a currently approved collection   No
Regular 09/28/2021
  Requested Previously Approved
36 Months From Approved 10/31/2021
5,000 5,000
500 167
13,600 9,870

This form is submitted to DoD to establish a Defense Enrollment Eligibility Reporting System (DEERS) record and surrogate association for issuance of a DoD Self-Service (DS) Logon. A surrogate may be established: (1) As the custodian of an unmarried minor child(ren) of a deceased Service member who is under age 18, who is at least 18 but under 23 and attending school full-time, or who is incapacitated. (2) As the agent of an incapacitated dependent (e.g., spouse, parent). (3) As the agent of a wounded, ill, or incapacitated Service member.

US Code: 10 USC 1044a
  
None

Not associated with rulemaking

  86 FR 39009 07/23/2021
86 FR 52135 09/20/2021
No

1
IC Title Form No. Form Name
Application for Surrogate Association for DoD Self-Service (DS) Logon Form DD Form 3005 Application for Surrogate Association for DoD Self-Service (DS) Logon

  Total Request 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 5,000 5,000 0 0 0 0
Annual Time Burden (Hours) 500 167 0 333 0 0
Annual Cost Burden (Dollars) 13,600 9,870 0 3,730 0 0
Yes
Miscellaneous Actions
No
Burden increased due to an increase in respondent's response time.

$3,863
No
    Yes
    Yes
No
No
No
No
LaTarsha Yeargins 571 372-2089 latarsha.r.yeargins.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.
09/28/2021


© 2024 OMB.report | Privacy Policy