16-F-1345 Doc02 1 of 55 Detailed Current Inventory … Room...3 of 55 Detailed Current Inventory...
55
08/15/2016 11:11 AM 55 1 of Detailed Current Inventory Report Department of Defense Agency: DOD/AF OMB Control Number: 0701-0070 Expiration Date: 04/30/2017 201403-0701-001 Title: Air Force Family Integrated Results & Statistical Tracking Automated System ICR AnnualResponses: 60,000 ICR Annual Hours: 15,000 ICR Annual Costs: $ 108,000 Information Collections: ICR Reference Number: Title Form Name Form Number Annual Responses Annual Hours Annual Cost Air Force Family Integrated Results & Statistical Tracking Automated System 60,000 15,000 $ 108,000 Agency: DOD/AF OMB Control Number: 0701-0101 Expiration Date: 09/30/2016 201308-0701-001 Title: Air Force ROTC College Scholarship Application ICR AnnualResponses: 15,000 ICR Annual Hours: 7,500 ICR Annual Costs: $ 67,500 Information Collections: ICR Reference Number: Title Form Name Form Number Annual Responses Annual Hours Annual Cost Air Force ROTC College Scholarship Application 15,000 7,500 $ 67,500 Agency: DOD/AF OMB Control Number: 0701-0114 Expiration Date: 02/28/2018 201408-0701-001 Title: Application for Establishment of Air Force Junior ROTC Unit ICR AnnualResponses: 200 ICR Annual Hours: 100 ICR Annual Costs: $ 2,000 Information Collections: ICR Reference Number: Title Form Name Form Number Annual Responses Annual Hours Annual Cost Application for Establishment of Air Force Junior ROTC Unit Application for Establishment of Air Force Junior ROTC Unit AFJROTC 59 200 100 $ 2,000 Agency: DOD/AF OMB Control Number: 0701-0127 Expiration Date: 09/30/2016 201305-0701-005 Title: USAF Museum System Volunteer Application/Registration ICR AnnualResponses: 198 ICR Annual Hours: 50 ICR Annual Costs: $ 893 Information Collections: ICR Reference Number: Title Form Name Form Number Annual Responses Annual Hours Annual Cost USAF Museum System Volunteer Application/Registration USAF Museum System Volunteer Application/Registration AF IMT 3569 198 50 $ 893 16-F-1345_Doc02
Transcript of 16-F-1345 Doc02 1 of 55 Detailed Current Inventory … Room...3 of 55 Detailed Current Inventory...
08/15/2016 11:11 AM 551 of Detailed Current Inventory Report
Department of Defense
Agency: DOD/AF OMB Control Number: 0701-0070Expiration Date: 04/30/2017 201403-0701-001Title: Air Force Family Integrated Results & Statistical Tracking Automated SystemICR AnnualResponses:60,000
ICR Annual Hours:15,000
ICR Annual Costs:$ 108,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostAir Force FamilyIntegrated Results &Statistical TrackingAutomated System
60,000 15,000 $ 108,000
Agency: DOD/AF OMB Control Number: 0701-0101Expiration Date: 09/30/2016 201308-0701-001Title: Air Force ROTC College Scholarship ApplicationICR AnnualResponses:15,000
ICR Annual Hours:7,500
ICR Annual Costs:$ 67,500
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostAir Force ROTC CollegeScholarship Application
15,000 7,500 $ 67,500
Agency: DOD/AF OMB Control Number: 0701-0114Expiration Date: 02/28/2018 201408-0701-001Title: Application for Establishment of Air Force Junior ROTC UnitICR AnnualResponses:200
ICR Annual Hours:100
ICR Annual Costs:$ 2,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostApplication forEstablishment of AirForce Junior ROTC Unit
Application forEstablishment of AirForce Junior ROTC Unit
AFJROTC 59 200 100 $ 2,000
Agency: DOD/AF OMB Control Number: 0701-0127Expiration Date: 09/30/2016 201305-0701-005Title: USAF Museum System Volunteer Application/RegistrationICR AnnualResponses:198
ICR Annual Hours:50
ICR Annual Costs:$ 893
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostUSAF Museum SystemVolunteerApplication/Registration
USAF Museum SystemVolunteerApplication/Registration
AF IMT 3569 198 50 $ 893
16-F-1345_Doc02
08/15/2016 11:11 AM 552 of Detailed Current Inventory Report
Department of Defense
Agency: DOD/AF OMB Control Number: 0701-0137Expiration Date: 10/31/2017 201409-0701-001Title: DoD Statement of IntentICR AnnualResponses:15
ICR Annual Hours:300
ICR Annual Costs:$ 15,150
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDOD Statement of Intent DoD Statement of Intent AMC Form 207 15 300 $ 15,150
Agency: DOD/AF OMB Control Number: 0701-0150Expiration Date: 07/31/2017 201404-0701-001Title: Air Force Recruiting Information Support System - Total Forces (AFRISS-TF)ICR AnnualResponses:1,300,000
ICR Annual Hours:3,900,000
ICR Annual Costs:$ 28,275,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostAir Force RecruitingInformation SupportSystem - Total Forces(AFRISS-TF)
Multiple Forms Tied toSystem
Multiple Forms Tied toSystem
1,300,000 3,900,000 $ 28,275,000
Agency: DOD/AF OMB Control Number: 0701-0159Expiration Date: 12/31/2016 201309-0701-001Title: Victim/Witness FeedbackICR AnnualResponses:16
ICR Annual Hours:4
ICR Annual Costs:$ 160
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostVictim/WitnessFeedback
16 4 $ 160
0701 AF Totals:
Type # Information Collections Total Annual Responses Total Annual Hours Total Annual CostICR 7 1,375,429 3,922,954 $ 28,468,703
$ 000 0RCF1,375,4297 $ 28,468,703Total 3,922,954
Agency: DOD/DOA OMB Control Number: 0702-0073Expiration Date: 04/30/2017 201401-0702-001Title: U.S. Army ROTC 4-year College Scholarship Application (for High School Students)ICR AnnualResponses:11,369
ICR Annual Hours:8,527
ICR Annual Costs:$ 200,616
Information Collections:
ICR Reference Number:
08/15/2016 11:11 AM 553 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostU.S. Army ROTC 4-yearCollege ScholarshipApplication (for HighSchool Students)
11,369 8,527 $ 200,616
Agency: DOD/DOA OMB Control Number: 0702-0109Expiration Date: 03/31/2017 201401-0702-002Title: Letter Permit for Non-Army Agency Radiation Sources on Army LandICR AnnualResponses:235
ICR Annual Hours:470
ICR Annual Costs:$ 16,920
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostLetter Permit for Non-Army Agency RadiationSources on Army Land
235 470 $ 16,920
Agency: DOD/DOA OMB Control Number: 0702-0111Expiration Date: 06/30/2017 201403-0702-001Title: Army ROTC Referral InformationICR AnnualResponses:21,000
ICR Annual Hours:5,250
ICR Annual Costs:$ 38,010
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostArmy ROTC ReferralInformation
21,000 5,250 $ 38,010
Agency: DOD/DOA OMB Control Number: 0702-0120Expiration Date: 02/28/2018 201412-0702-003Title: The Contractor Manpower Reporting SystemICR AnnualResponses:12,215
ICR Annual Hours:1,018
ICR Annual Costs:$ 20,399
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostThe ContractorManpower ReportingSystem
12,215 1,018 $ 20,399
Agency: DOD/DOA OMB Control Number: 0702-0125Expiration Date: 01/31/2017 201311-0702-001Title: Automated Installation Entry (AIE) SystemICR AnnualResponses:29,385
ICR Annual Hours:1,469
ICR Annual Costs:$ 42,814
Information Collections:
ICR Reference Number:
08/15/2016 11:11 AM 554 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostAutomated InstallationEntry (AIE) System
29,385 1,469 $ 42,814
Agency: DOD/DOA OMB Control Number: 0702-0126Expiration Date: 02/28/2017 201312-0702-001Title: Suppliers Self-Services - SUSICR AnnualResponses:22,404
ICR Annual Hours:2,240
ICR Annual Costs:$ 35,846
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostSUS Portal 22,404 2,240 $ 35,846
Agency: DOD/DOA OMB Control Number: 0702-0127Expiration Date: 09/30/2017 201408-0702-001Title: Automated Biometric Identification System (ABIS)ICR AnnualResponses:2,422,475
ICR Annual Hours:208,000
ICR Annual Costs:$ 20,933,120
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostBiometric System 2,422,475 208,000 $ 20,933,120
Agency: DOD/DOA OMB Control Number: 0702-0128Expiration Date: 01/31/2019 201512-0702-002Title: Army Sex Offender InformationICR AnnualResponses:550
ICR Annual Hours:183
ICR Annual Costs:$ 5,336
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostALERTS System Military Police Report DA 3975 550 183 $ 5,336
Agency: DOD/DOA OMB Control Number: 0702-0129Expiration Date: 12/31/2018 201511-0702-001Title: Exchange Official Personnel Folder - Privilege CardICR AnnualResponses:2,500
ICR Annual Hours:625
ICR Annual Costs:$ 4,525
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 555 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostIdentification andPrivilege CardApplication
Dependent Card,Army &Air Force ExchangeService Identification &Privilege CardApplication
DD Form 2574,ExchangeForm 1100-016
2,500 625 $ 4,525
Agency: DOD/DOA OMB Control Number: 0702-0130Expiration Date: 12/31/2018 201511-0702-002Title: Exchange Retail Sales Transaction Data SurveysICR AnnualResponses:595,968
ICR Annual Hours:29,798
ICR Annual Costs:$ 214,548
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost2015 ExchangeCustomer SatisfactionSurvey
595,968 29,798 $ 214,548
Agency: DOD/DOA OMB Control Number: 0702-0131Expiration Date: 01/31/2019 201511-0702-003Title: Employee Travel FilesICR AnnualResponses:350
ICR Annual Hours:263
ICR Annual Costs:$ 1,904
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostHR Relocation RequestTemplates
350 263 $ 1,904
Agency: DOD/DOA OMB Control Number: 0702-0132Expiration Date: 01/31/2019 201512-0702-001Title: Application for Temporary Food EstablishmentICR AnnualResponses:91
ICR Annual Hours:23
ICR Annual Costs:$ 531
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostApplication forTemporary FoodEstablishment
Application forTemporary FoodEstablishment
DD Form 2970 91 23 $ 531
Agency: DOD/DOA OMB Control Number: 0702-0133Expiration Date: 03/31/2019 201601-0702-001Title: Exchange Employment ApplicationsICR AnnualResponses:73,390
ICR Annual Hours:55,043
ICR Annual Costs:$ 399,242
ICR Reference Number:
08/15/2016 11:11 AM 556 of Detailed Current Inventory Report
Department of Defense
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostExchange EmploymentApplications
AAFES Turkey, Italy,and UK employmentapplications
Exchange Form 1200-026, 1200-718
73,390 55,043 $ 399,242
Agency: DOD/DOA OMB Control Number: 0702-0134Expiration Date: 04/30/2019 201603-0702-001Title: Department of Defense (DoD) Passport and Passport Agent Services, Authorization to Apply for a "No-Fee" PassportICR AnnualResponses:175,000
ICR Annual Hours:175,000
ICR Annual Costs:$ 1,268,750
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDepartment of Defense(DoD) Passport andPassport AgentServices, Authorizationto Apply for a "No-Fee"Passport and/orRequest for Visa
Authorization to Applyfor a "No-Fee" Passportand/or Request for Visa
DD Form 1056 175,000 175,000 $ 1,268,750
Agency: DOD/DOA OMB Control Number: 0702-0135Expiration Date: 06/30/2019 201604-0702-001Title: Exchange Security Clearance Process for Contractor/Vendor PersonnelICR AnnualResponses:2,300
ICR Annual Hours:4,600
ICR Annual Costs:$ 33,350
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostExchange SecurityClearance Process forContractor/VendorPersonnel
Background Check forVendors/Contractors,e-QIP RequestForm,TASS Request
Exchange Form 3900-006,Exchange Form3900-013,ExchangeForm 3900-002
2,300 4,600 $ 33,350
Agency: DOD/DOA OMB Control Number: 0702-0136Expiration Date: 08/31/2019 201606-0702-001Title: Army Career Tracker (ACT)ICR AnnualResponses:173,338
ICR Annual Hours:28,890
ICR Annual Costs:$ 577,793
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostSponsorship ProgramCounseling andInformation Sheet
Sponsorship Programand CounselingInformationSheet,SponsorshipProgram Counselingand Information Sheet
DA 5434,DA 5434 173,338 28,890 $ 577,793
08/15/2016 11:11 AM 557 of Detailed Current Inventory Report
Department of Defense
0702 DOA Totals:
Type # Information Collections Total Annual Responses Total Annual Hours Total Annual CostICR 16 3,542,570 521,399 $ 23,793,704
$ 000 0RCF3,542,57016 $ 23,793,704Total 521,399
Agency: DOD/NAVY OMB Control Number: 0703-0020Expiration Date: 06/30/2017 201404-0703-001Title: Enlistee Financial StatementICR AnnualResponses:5,000
ICR Annual Hours:2,750
ICR Annual Costs:$ 66,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostEnlistee FinancialStatement
Enlistee FinancialStatement
NAVCRUIT 1130/13 5,000 2,750 $ 66,000
Agency: DOD/NAVY OMB Control Number: 0703-0053Expiration Date: 09/30/2017 201407-0703-001Title: Marine Corps Marathon Race ApplicationsICR AnnualResponses:64,725
ICR Annual Hours:21,575
ICR Annual Costs:$ 156,419
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostMarine Corps MarathonRace Applications
64,725 21,575 $ 156,419
Agency: DOD/NAVY OMB Control Number: 0703-0059Expiration Date: 02/28/2017 201311-0703-002Title: JAG Corps Applicant SurveyICR AnnualResponses:800
ICR Annual Hours:600
ICR Annual Costs:$ 4,584
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostJAG Corps ApplicantSurvey
800 600 $ 4,584
Agency: DOD/NAVY OMB Control Number: 0703-0060Expiration Date: 03/31/2017 201402-0703-001Title: U.S. NavyvChief of Information Sponsor ApplicationICR AnnualResponses:3,000
ICR Annual Hours:750
ICR Annual Costs:$ 0
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 558 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostU.S. NavyvChief ofInformation SponsorApplication
3,000 750 $ 0
Agency: DOD/NAVY OMB Control Number: 0703-0061Expiration Date: 03/31/2017 201402-0703-002Title: Navy Enabler FrameworkICR AnnualResponses:4,900,000
ICR Annual Hours:408,333
ICR Annual Costs:$ 66,331,300
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostEnabler Framework Department of the Navy
Local Population IDCard/ Base Access PassRegistration
SECNAV 5512/1 4,900,000 408,333 $ 66,331,300
Agency: DOD/NAVY OMB Control Number: 0703-0062Expiration Date: 04/30/2018 201412-0703-001Title: Personalized Recruiting for Immediate and Delayed Enlistment Modernization (PRIDE Mod)ICR AnnualResponses:60,000
ICR Annual Hours:60,000
ICR Annual Costs:$ 697,800
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostPRIDE Mod System 60,000 60,000 $ 697,800
Agency: DOD/NAVY OMB Control Number: 0703-0063Expiration Date: 11/30/2018 201510-0703-001Title: Department of the Navy (DON) Reasonable Accommodations (RA) TrackerICR AnnualResponses:100
ICR Annual Hours:33
ICR Annual Costs:$ 1,543
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostConfirmation ofReasonableAccommodationRequest
Confirmation ofReasonableAccommodationRequest
SECNAV 12306/1T 100 33 $ 1,543
Agency: DOD/NAVY OMB Control Number: 0703-0064Expiration Date: 07/31/2017 201512-0703-001Title: Prospective Studies of US Military Forces: The Millennium Cohort StudyICR AnnualResponses:50,323
ICR Annual Hours:37,742
ICR Annual Costs:$ 0
Information Collections:
ICR Reference Number:
08/15/2016 11:11 AM 559 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostProspective Studies ofUS Military Forces: TheMillennium Cohort Study
50,323 37,742 $ 0
Agency: DOD/NAVY OMB Control Number: 0703-0065Expiration Date: 07/31/2019 201605-0703-001Title: Risk Management Information (RMI) SystemICR AnnualResponses:25
ICR Annual Hours:38
ICR Annual Costs:$ 1,001
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostRisk ManagementInformation System
Safety InvestigationReport Advice toWitness - Promise ofConfidentiality
OPNAVINST 5102.1 25 38 $ 1,001
0703 NAVY Totals:
Type # Information Collections Total Annual Responses Total Annual Hours Total Annual CostICR 9 5,083,973 531,821 $ 67,258,647
$ 000 0RCF5,083,9739 $ 67,258,647Total 531,821
Agency: DOD/DODDEP OMB Control Number: 0704-0003Expiration Date: 12/31/2017 201410-0704-009Title: Application for Correction of Military Record Under the Provisions of Title 10, U.S. Code, Section 1552ICR AnnualResponses:36,110
ICR Annual Hours:18,055
ICR Annual Costs:$ 130,899
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostApplication forCorrection of MilitaryRecord Under theProvisions of Title 10,U.S. Code, Section 1552
Application forCorrection of MilitaryRecord
DD Form 149 36,110 18,055 $ 130,899
Agency: DOD/DODDEP OMB Control Number: 0704-0004Expiration Date: 12/31/2017 201410-0704-010Title: Application for the Review of Discharge from the Armed Forces of the United StatesICR AnnualResponses:10,000
ICR Annual Hours:7,500
ICR Annual Costs:$ 54,375
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 5510 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostApplication for theReview of Dischargefrom the Armed Forcesof the United States
Application for theReview of Dischargefrom the Armed Forcesof the US.
DD Form 293 10,000 7,500 $ 54,375
Agency: DOD/DODDEP OMB Control Number: 0704-0007Expiration Date: 12/31/2017 201410-0704-011Title: Police Records CheckICR AnnualResponses:175,000
ICR Annual Hours:78,750
ICR Annual Costs:$ 1,377,250
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostPolice Records Check Police Record Check DD Form 369 175,000 78,750 $ 1,377,250
Agency: DOD/DODDEP OMB Control Number: 0704-0030Expiration Date: 03/31/2019 201602-0704-001Title: Disposition of Remains - Reimbursable Basis Request for Payment of Funeral and/or Internment ExpensesICR AnnualResponses:2,450
ICR Annual Hours:1,224
ICR Annual Costs:$ 12,985
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDisposition of Remains -Reimbursable BasisRequest for Payment ofFuneral and/or IntermentExpenses
Request for Payment ofFuneral and/or IntermentExpenses,Disposition ofRemains -Reimburseable Basis
DD Form 1375,DD Form2065
2,450 1,224 $ 12,985
Agency: DOD/DODDEP OMB Control Number: 0704-0125Expiration Date: 08/31/2017 201405-0704-007Title: 2014 Post-Election Voting Survey of Local Election OfficialsICR AnnualResponses:900
ICR Annual Hours:300
ICR Annual Costs:$ 6,129
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost2014 Post-electionVoting Survey of LocalElection Officials
900 300 $ 6,129
Agency: DOD/DODDEP OMB Control Number: 0704-0152Expiration Date: 01/31/2017 201311-0704-006Title: DOD Education Loan Repayment ProgramICR AnnualResponses:22,391
ICR Annual Hours:3,732
ICR Annual Costs:$ 69,412
ICR Reference Number:
08/15/2016 11:11 AM 5511 of Detailed Current Inventory Report
Department of Defense
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDOD Education LoanRepayment Program
DOD Education LoanRepayment Program
DD Form 2475 22,391 3,732 $ 69,412
Agency: DOD/DODDEP OMB Control Number: 0704-0173Expiration Date: 09/30/2017 201407-0704-007Title: Record of Military Processing - Armed Forces of the United StatesICR AnnualResponses:423,000
ICR Annual Hours:296,100
ICR Annual Costs:$ 2,164,724
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostRecord of MilitaryProcessing - ArmedForces of the UnitedStates
Record of MilitaryProcessing - ArmedForces of the UnitedStates,Request forExamination,Record ofMilitary Processing -Armed Forces of theUnitedStates,USMEPCOMFORM 680-3
DD Form1966,USMEPCOMFORM 680-3A-E,DDForm 1966,Request for
423,000 296,100 $ 2,164,724
Agency: DOD/DODDEP OMB Control Number: 0704-0187Expiration Date: 07/31/2018 201505-0704-002Title: Information Collection in Support of the DoD Acquisition Process (Various Miscellaneous Requirements)ICR AnnualResponses:1,062
ICR Annual Hours:1,464
ICR Annual Costs:$ 55,631
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostInformation Collection inSupport of the DODAcquisition Process(Solicitation Phase)
1,062 1,464 $ 55,631
Agency: DOD/DODDEP OMB Control Number: 0704-0188Expiration Date: 08/31/2016 201306-0704-006Title: ASSIST DatabaseICR AnnualResponses:492,480
ICR Annual Hours:32,503,680
ICR Annual Costs:$ 1,300,147,200
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostAcquisition ManagementSystems and DataRequirements ControlList (AMSDL): ASSIST
492,480 32,503,680 $1,300,147,20
0
08/15/2016 11:11 AM 5512 of Detailed Current Inventory Report
Department of Defense
Agency: DOD/DODDEP OMB Control Number: 0704-0190Expiration Date: 12/31/2017 201410-0704-008Title: Appointment of Chaplains for the Military ServicesICR AnnualResponses:1,040
ICR Annual Hours:780
ICR Annual Costs:$ 27,160
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostAppointment ofChaplains for the MilitaryServices
Statement ofEcclesiasticalEndorsement
DD Form 2088 1,040 780 $ 27,160
Agency: DOD/DODDEP OMB Control Number: 0704-0207Expiration Date: 03/31/2019 201601-0704-003Title: Militarily Critical Technical Data AgreementICR AnnualResponses:8,000
ICR Annual Hours:2,667
ICR Annual Costs:$ 112,213
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostMilitarily CriticalTechnical DataAgreement
Militarily CriticalTechnical DataAgreement
DD 2345 8,000 2,667 $ 112,213
Agency: DOD/DODDEP OMB Control Number: 0704-0214Expiration Date: 02/28/2018 201501-0704-001Title: Defense Federal Acquisition Regulation Supplement (DFARS) Part 217, Special Contracting Methods, and related clausesICR AnnualResponses:102,139
ICR Annual Hours:886,703
ICR Annual Costs:$ 33,513,791
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Part 217, SpecialContracting Methods,and related clauses at252.217
102,139 886,703 $ 33,513,791
Agency: DOD/DODDEP OMB Control Number: 0704-0216Expiration Date: 08/31/2016 201306-0704-004Title: Defense Federal Acquisition Regulation Supplement (DFARS) Part 228, Bonds and Insurance, and Related Clauses atICR AnnualResponses:125
ICR Annual Hours:471
ICR Annual Costs:$ 20,418
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 5513 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Part 228, Bonds andInsurance, and RelatedClauses at 252.228
125 471 $ 20,418
Agency: DOD/DODDEP OMB Control Number: 0704-0225Expiration Date: 03/31/2017 201411-0704-001Title: Defense Federal Acquisition Regulation Supplement Part 204, Administrative Matters, and related clauses at 252.204ICR AnnualResponses:3,707
ICR Annual Hours:11,121
ICR Annual Costs:$ 85,471
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSuppement Part 204,Administrative Matters,and related clauses at252.204
3,707 11,121 $ 85,471
Agency: DOD/DODDEP OMB Control Number: 0704-0229Expiration Date: 03/31/2017 201411-0704-009Title: Defense Federal Acquisition Regulation Supplement Part 225, Foreign Acquisition, and related clausesICR AnnualResponses:208,667
ICR Annual Hours:64,031
ICR Annual Costs:$ 2,369,472
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement Part 225,Foreign Acquisition, andrelated clauses
Report of ContractPerformance Outsidethe United States
DD Form 2139 208,667 64,031 $ 2,369,472
Agency: DOD/DODDEP OMB Control Number: 0704-0231Expiration Date: 03/31/2017 201401-0704-006Title: Defense Federal Acquisition Regulation Supplement (DFARS) Subpart 237, Service Contracting, associated DFARSICR AnnualResponses:9,560
ICR Annual Hours:17,905
ICR Annual Costs:$ 550,611
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 5514 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Subpart 237, ServiceContracting, associatedDFARS Clauses atDFARS 252.237, andDD Form 2063, Recordof Preparation...
Record of Preparationand Disposition ofRemains
DD Form 2063 9,560 17,905 $ 550,611
Agency: DOD/DODDEP OMB Control Number: 0704-0232Expiration Date: 03/31/2017 201401-0704-007Title: Defense Federal Acquisiton Regulation Supplement (DFARS) Subpart 215.4, Contract Pricing, and related clauses atICR AnnualResponses:53,458
ICR Annual Hours:538,480
ICR Annual Costs:$ 16,630,366
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisiton RegulationSupplement (DFARS)Subpart 215.4, ContractPricing, and relatedclauses at DFARS252.215 and DD Form1861
Contract FacilitiesCapital Cost of Money
DD Form 1861 53,458 538,480 $ 16,630,366
Agency: DOD/DODDEP OMB Control Number: 0704-0245Expiration Date: 11/30/2017 201410-0704-005Title: Defense Federal Acquisition Regulation Supplement (DFARS) Part 247, Transportation, and related clauses at 252.247ICR AnnualResponses:417,341
ICR Annual Hours:166,420
ICR Annual Costs:$ 6,261,436
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Part 247,Transportation, andrelated clauses at252.247
Application for U.S.Government ShippingDocumentation/Instructions
DD 1659 417,341 166,420 $ 6,261,436
Agency: DOD/DODDEP OMB Control Number: 0704-0246Expiration Date: 08/31/2018 201506-0704-002Title: Defense Federal Acquisition Regulations Supplement (DFARS) Part 245, Government Property, related clauses in DFARSICR AnnualResponses:27,404
ICR Annual Hours:28,283
ICR Annual Costs:$ 1,100,345
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 5515 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationsSupplement (DFARS)Part 245, GovernmentProperty, relatedclauses in DFARS 252,and related forms inDFARS 253.
Invoice/ShippingDocument,ISSUERELEASE/RECEIPTDOCUMENT,Invoice/Shipping Document(ContinuationSheet),Request for PlantClearance,ScrapWarranty
DD-1149,DoD Form1348-1a,DD-1149C,DD-1640,DD-1639
27,404 28,283 $ 1,100,345
Agency: DOD/DODDEP OMB Control Number: 0704-0248Expiration Date: 11/30/2017 201410-0704-006Title: Defense Federal Acquisition Regulation Supplement, Appendix F, Inspection and Receiving ReportICR AnnualResponses:2,352,941
ICR Annual Hours:209,804
ICR Annual Costs:$ 6,503,924
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement, AppendixF, Inspection andReceiving Report
Material Inspection andReceiving Report -continuationsheet,MaterialInspection andReceiving Report,Tanker/Barge MaterialInspection and
DD Form 250c,DD Form250,DD Form 250-1
2,352,941 209,804 $ 6,503,924
Agency: DOD/DODDEP OMB Control Number: 0704-0250Expiration Date: 05/31/2019 201604-0704-002Title: Defense Federal Acquisition Regulation Supplement (DFARS) Part 242, Contract Administration and Related Clause inICR AnnualResponses:94,963
ICR Annual Hours:192,372
ICR Annual Costs:$ 8,177,961
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Part 242, ContractAdministration andRelated Clause inDFARS 252
94,963 192,372 $ 8,177,961
Agency: DOD/DODDEP OMB Control Number: 0704-0252Expiration Date: 09/30/2017 201408-0704-006Title: Defense Federal Acquisition Regulation Supplement, Use of Government Sources by Contractors, and related clauses inICR AnnualResponses:10,500
ICR Annual Hours:5,250
ICR Annual Costs:$ 163,091
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 5516 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement, Use ofGovernment Sources byContractors, and relatedclauses in Part 252
10,500 5,250 $ 163,091
Agency: DOD/DODDEP OMB Control Number: 0704-0253Expiration Date: 03/31/2017 201401-0704-008Title: Subcontracting Policies and Procedures -- DoD FAR Supplement Part 244ICR AnnualResponses:90
ICR Annual Hours:1,440
ICR Annual Costs:$ 53,280
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostSubcontracting Policiesand Procedures -- DoDFAR Supplement Part244
90 1,440 $ 53,280
Agency: DOD/DODDEP OMB Control Number: 0704-0255Expiration Date: 09/30/2018 201508-0704-002Title: Defense_Federal Acquisition Regulation Supplement (DFARS) Part 236, Construction and Architect-Engineer Contracts,ICR AnnualResponses:3,398
ICR Annual Hours:342,315
ICR Annual Costs:$ 13,007,970
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense_FederalAcquisition RegulationSupplement (DFARS)Part 236, Constructionand Architect-EngineerContracts, and relatedclauses at 252.236
3,398 342,315 $ 13,007,970
Agency: DOD/DODDEP OMB Control Number: 0704-0259Expiration Date: 12/31/2017 201411-0704-007Title: Defense Federal Acquisition Regulation Suuplement (DFARS) Part 216, Types of Contracts, and related clauses in PartICR AnnualResponses:1,949
ICR Annual Hours:7,844
ICR Annual Costs:$ 243,164
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSuuplement (DFARS)Part 216, Types ofContracts, and relatedclauses in Part 252.216
1,949 7,844 $ 243,164
08/15/2016 11:11 AM 5517 of Detailed Current Inventory Report
Department of Defense
Agency: DOD/DODDEP OMB Control Number: 0704-0261Expiration Date: 04/30/2019 201603-0704-001Title: Department of Defense Standard Tender of Freight ServicesICR AnnualResponses:170,825
ICR Annual Hours:56,372
ICR Annual Costs:$ 763,588
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDepartment of DefenseStandard Tender ofFreight Services
Department of DefenseStandard Tender ofFreight Services
SDDC Form 364-R 170,825 56,372 $ 763,588
Agency: DOD/DODDEP OMB Control Number: 0704-0272Expiration Date: 10/31/2017 201408-0704-007Title: Defense Federal Acqisition Regulation Supplement (DFARS) Part 223, Occupational Safety and Drug-Free Workforce; andICR AnnualResponses:13,862
ICR Annual Hours:675,079
ICR Annual Costs:$ 140,685
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcqisition RegulationSupplement (DFARS)Part 223, OccupationalSafety and Drug-FreeWorkforce; and relatedclauses in DFARS252.223
13,862 675,079 $ 140,685
Agency: DOD/DODDEP OMB Control Number: 0704-0286Expiration Date: 03/31/2017 201401-0704-009Title: Defense FAR Supplement (DFARS) Part 205, Publicizing Contract Actions, and DFARS 252-205-7000, Provision ofICR AnnualResponses:7,000
ICR Annual Hours:7,700
ICR Annual Costs:$ 236,775
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FARSupplement (DFARS)Part 205, PublicizingContract Actions, andDFARS 252-205-7000,Provision of Informationto CooperativeAgreement Holders
7,000 7,700 $ 236,775
Agency: DOD/DODDEP OMB Control Number: 0704-0290Expiration Date: 09/30/2016 201308-0704-006Title: Armed Forces Participation in Public EventsICR AnnualResponses: ICR Annual Hours: ICR Annual Costs:
ICR Reference Number:
08/15/2016 11:11 AM 5518 of Detailed Current Inventory Report
Department of Defense
51,000 17,850 $ 249,007
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostArmed ForcesParticipation in PublicEvents
Request for MilitaryAerial Support,Requestfor Armed ForcesParticipation in PublicEvents (Non-Aviation)
DD-2535,DD-2536 51,000 17,850 $ 249,007
Agency: DOD/DODDEP OMB Control Number: 0704-0320Expiration Date: 10/31/2018 201509-0704-005Title: Procurement Technical Assistance Center Cooperative Agreement Performance ReportICR AnnualResponses:380
ICR Annual Hours:2,660
ICR Annual Costs:$ 66,500
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostProcurement TechnicalAssistance CenterCooperative AgreementPerformance Report
PROCUREMENTTECHNICALASSISTANCE CENTERCooperative AgreementPerformance Report
DL1806 380 2,660 $ 66,500
Agency: DOD/DODDEP OMB Control Number: 0704-0321Expiration Date: 01/31/2019 201512-0704-008Title: Defense Federal Acquisition Regulation Supplement (DFARS) Part 232, Contract Financing, and the clauses at DFARSICR AnnualResponses:3,298
ICR Annual Hours:4,947
ICR Annual Costs:$ 159,953
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Part 232, ContractFinancing, and theclauses at DFARS252.232-7002 ProgressPayments for ForeignMilitary...
3,298 4,947 $ 159,953
Agency: DOD/DODDEP OMB Control Number: 0704-0332Expiration Date: 09/30/2016 201308-0704-005Title: Defense Federal Acquisition Regulation Supplement (DFARS) Appendix IICR AnnualResponses:225
ICR Annual Hours:582
ICR Annual Costs:$ 21,534
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 5519 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Appendix I
225 582 $ 21,534
Agency: DOD/DODDEP OMB Control Number: 0704-0334Expiration Date: 09/30/2017 201407-0704-008Title: Automated Repatriation Reporting SystemICR AnnualResponses:100
ICR Annual Hours:33
ICR Annual Costs:$ 760
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostAutomated RepatriationReporting System
Repatriation ProcessingCenter ProcessingSheet -Instructions,RepatriationProcessing CenterProcessing Sheet
DD Form 2585,DD Form2585
100 33 $ 760
Agency: DOD/DODDEP OMB Control Number: 0704-0341Expiration Date: 12/31/2017 201411-0704-003Title: Defense Federal Acquisition Regulation Supplement (DFARS) Part 239, Acquisition of Information Technology, andICR AnnualResponses:12,915
ICR Annual Hours:7,106
ICR Annual Costs:$ 196,210
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Part 239, Acquisition ofInformation Technology,and associated clausesat DFARS 252.239-7000and 252.239-7006
12,915 7,106 $ 196,210
Agency: DOD/DODDEP OMB Control Number: 0704-0359Expiration Date: 03/31/2017 201401-0704-011Title: Defense Federal Acquisition Regulation Supplement (DFARS) Part 232, Contract Financing, and related clause at DFARSICR AnnualResponses:800
ICR Annual Hours:800
ICR Annual Costs:$ 42,400
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 5520 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Part 232, ContractFinancing, and relatedclause at DFARS252.232-7007,Limitation ofGovernment's Obligation
800 800 $ 42,400
Agency: DOD/DODDEP OMB Control Number: 0704-0368Expiration Date: 11/30/2017 201410-0704-002Title: National Security Education Program (Service Agreement Report for Scholarship and Fellowship Awards)ICR AnnualResponses:1,650
ICR Annual Hours:275
ICR Annual Costs:$ 2,182
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostNational SecurityEducation Program(Service AgreementReport for Scholarshipand Fellowship Awards)
National SecurityEducation Program(NSEP) ServiceAgreement forScholarship andFellowshipAwards,NationalSecurity EducationProgram (NSEP)Service AgreementReport (SAR) forScholarship and
DD Form 2752,DD Form2753
1,650 275 $ 2,182
Agency: DOD/DODDEP OMB Control Number: 0704-0369Expiration Date: 09/30/2016 201307-0704-004Title: DFARS: Subparts 227.71, Rights in Technical Data; and 227.72, Rights in computer software and computer softwareICR AnnualResponses:846,135
ICR Annual Hours:978,801
ICR Annual Costs:$ 24,571,530
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Subparts 227.71, Rightsin Technical Data; and227.72, Rights incomputer software andcomputer softwaredocumentation, and ......
846,135 978,801 $ 24,571,530
Agency: DOD/DODDEP OMB Control Number: 0704-0386Expiration Date: 09/30/2017 201408-0704-005Title: Defense Federal Acquisition Regulation Supplement (DFARS) Part 219, Small Business Programs and associated clausesICR AnnualResponses: ICR Annual Hours: ICR Annual Costs:
ICR Reference Number:
08/15/2016 11:11 AM 5521 of Detailed Current Inventory Report
Department of Defense
41 41 $ 1,541
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Part 219, SmallBusiness Programs andassociated clauses inpart 252.219
41 41 $ 1,541
Agency: DOD/DODDEP OMB Control Number: 0704-0390Expiration Date: 12/31/2017 201411-0704-002Title: Defense Federal Acquisition Regulation Supplment (DFARS) Part 229, Taxes, and related clauses at 252.229ICR AnnualResponses:40
ICR Annual Hours:160
ICR Annual Costs:$ 4,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplment (DFARS)Part 229, Taxes, andrelated clauses at252.229
40 160 $ 4,000
Agency: DOD/DODDEP OMB Control Number: 0704-0392Expiration Date: 07/31/2019 201603-0704-004Title: Technical Assistance for Public Participation (TAPP) ApplicationICR AnnualResponses:50
ICR Annual Hours:200
ICR Annual Costs:$ 8,874
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostTechnical Assistance forPublic Participation(TAPP) Application
Technical Assistance forPublic Participation(TAPP)Application,TechnicalAssistance for PublicParticipation (TAPP)
DD Form 2749,DD Form2749
50 200 $ 8,874
Agency: DOD/DODDEP OMB Control Number: 0704-0395Expiration Date: 02/28/2019 201512-0704-009Title: Pentagon Facilities Parking ProgramICR AnnualResponses:4,200
ICR Annual Hours:350
ICR Annual Costs:$ 12,810
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 5522 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostPentagon ReservationParking PermitApplication
Pentagon ReservationParking PermitApplication
DD-1199 4,200 350 $ 12,810
Agency: DOD/DODDEP OMB Control Number: 0704-0397Expiration Date: 09/30/2018 201508-0704-003Title: Defense Federal Acquisition Regulation Supplement (DFARS) Part 243, Contract Modifications and related clauses atICR AnnualResponses:520
ICR Annual Hours:2,483
ICR Annual Costs:$ 94,354
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Part 243, ContractModifications andrelated clauses atDFARS 252.243-7002
520 2,483 $ 94,354
Agency: DOD/DODDEP OMB Control Number: 0704-0398Expiration Date: 03/31/2017 201505-0704-004Title: Defense Acquisition Regulation Supplement (DFARS) Part 211, Describing Agency Needs, and related clause at DFARSICR AnnualResponses:22,573
ICR Annual Hours:23,136
ICR Annual Costs:$ 827,216
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense AquisitionRegulation Supplement(DFARS) Part 211,Describing AgencyNeeds, and relatedclause at DFARS252.211
22,573 23,136 $ 827,216
Agency: DOD/DODDEP OMB Control Number: 0704-0403Expiration Date: 08/31/2016 201306-0704-008Title: Customer Satisfaction Surveys - Generic ClearanceICR AnnualResponses:18,300
ICR Annual Hours:1,908
ICR Annual Costs:$ 68,958
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostCustomer SatisfactionSurveys
5,500 573 $ 20,724
Information AnalysisCenter (IACs) CustomerSatisfaction Survey
150 25 $ 865
08/15/2016 11:11 AM 5523 of Detailed Current Inventory Report
Department of Defense
Agency: DOD/DODDEP OMB Control Number: 0704-0411Expiration Date: 07/31/2017 201406-0704-002Title: Exceptional Family Member ProgramICR AnnualResponses:44,555
ICR Annual Hours:20,072
ICR Annual Costs:$ 648,903
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostExceptional FamilyMember Program
Special Education/EarlyInterventionSummary,FamilyMember Medical
DD Form 2792-I,DD Form2792
44,555 20,072 $ 648,903
Agency: DOD/DODDEP OMB Control Number: 0704-0413Expiration Date: 10/31/2017 201408-0704-009Title: Medical Screening of Military PersonnelICR AnnualResponses:773,003
ICR Annual Hours:128,834
ICR Annual Costs:$ 934,043
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostMedical Screening ofMilitary Personnel
Accessions MedicalPrescreenReporty,Report ofMedical History
DD Form 2807-2,DDForm 2807-1
773,003 128,834 $ 934,043
Agency: DOD/DODDEP OMB Control Number: 0704-0415Expiration Date: 01/31/2017 201311-0704-003Title: Application for Department of Defense Common Access Card - DEERS EnrollmentICR AnnualResponses:2,700,000
ICR Annual Hours:135,000
ICR Annual Costs:$ 8,684,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostApplication forDepartment of DefenseCommon Access Card -DEERS Enrollment
Application forDepartment of DefenseCommon Access Card -DEERS Enrollment
DD Form 1172-2 2,700,000 135,000 $ 8,684,000
Agency: DOD/DODDEP OMB Control Number: 0704-0417Expiration Date: 01/31/2018 201412-0704-001Title: Personnel Security Investigation Projection for Industry SurveyICR AnnualResponses:13,137
ICR Annual Hours:20,800
ICR Annual Costs:$ 762,537
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 5524 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostPersonnel SecurityInvestigation Projectionfor Industry Survey(DSS Form 232)
13,137 20,800 $ 762,537
Agency: DOD/DODDEP OMB Control Number: 0704-0420Expiration Date: 10/31/2017 201408-0704-004Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery.ICR AnnualResponses:70,500
ICR Annual Hours:3,525
ICR Annual Costs:$ 80,370
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostGeneric Clearance forthe Collection ofQualitative Feedback onAgency ServiceDelivery.
58,500 2,925 $ 66,690
2015 InfoNet ServicesAwareness andCustomer SatisfactionSurvey
800 67 $ 0
JCS Migration CustomerSatisfaction CommentCard
1,550 78 $ 1,938
JSP Testing andEvaluation Services -Awareness andSatisfaction Survey
70 2 $ 200
Agency: DOD/DODDEP OMB Control Number: 0704-0425Expiration Date: 04/30/2017 201403-0704-001Title: Application for Department of Defense Impact Aid for Children with Severe DisabilitiesICR AnnualResponses:50
ICR Annual Hours:400
ICR Annual Costs:$ 14,700
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostApplication forDepartment of DefenseImpact Aid for Childrenwith Severe Disabilities
Application forDepartment of DefenseImpact Aid for Childrenwith Severe Disabilities,Application forDepartment of DefenseImpact Aid for Childrenwith Severe Disabilities(Continuation Page)
Secretary of DefenseForm 816,Secretary ofDefense Form 816-C
50 400 $ 14,700
Agency: DOD/DODDEP OMB Control Number: 0704-0434Expiration Date: 08/31/2016 201307-0704-003Title: DFARS; Radio Frequency Identification Advance Shipment NoticesICR AnnualResponses: ICR Annual Hours: ICR Annual Costs:
ICR Reference Number:
08/15/2016 11:11 AM 5525 of Detailed Current Inventory Report
Department of Defense
8,940,996 3,354 $ 54,201
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS);Radio FrequencyIdentification AdvanceShipment Notices
8,940,996 3,354 $ 54,201
Agency: DOD/DODDEP OMB Control Number: 0704-0441Expiration Date: 08/31/2016 201307-0704-001Title: DFARS; Notification Requirements for Critical Safety ItemsICR AnnualResponses:250
ICR Annual Hours:250
ICR Annual Costs:$ 11,250
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS);NotificationRequirements for CriticalSafety Items
250 250 $ 11,250
Agency: DOD/DODDEP OMB Control Number: 0704-0446Expiration Date: 09/30/2017 201408-0704-008Title: Defense Federal Acquisition Regulation Supplement: Evaluation Factor for Use of Members of the Armed Forces SelectedICR AnnualResponses:100
ICR Annual Hours:100
ICR Annual Costs:$ 3,100
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement: EvaluationFactor for Use ofMembers of the ArmedForces SelectedReserve
100 100 $ 3,100
Agency: DOD/DODDEP OMB Control Number: 0704-0447Expiration Date: 06/30/2017 201405-0704-002Title: Nuclear Test Personnel Review FormsICR AnnualResponses:370
ICR Annual Hours:463
ICR Annual Costs:$ 11,563
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 5526 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostNuclear Test PersonnelReview Forms
Nuclear Test PersonnelReview InformationRequest andRelease,Questionnairefor Continental UnitedStates TestParticipants,Questionnaire for Crossroads TestParticipants,Questionnaire for Oceanic TestParticipants
DTRA Form 150,DTRAForm 150-A,DTRA Form150-C,DTRA Form 150-B
370 463 $ 11,563
Agency: DOD/DODDEP OMB Control Number: 0704-0449Expiration Date: 11/30/2018 201510-0704-007Title: National Language Service Corps (NSLC)ICR AnnualResponses:4,500
ICR Annual Hours:1,218
ICR Annual Costs:$ 12,411
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostNational LanguageService Corps Pilot
National LanguageService Corps (NLSC)Detailed Skill Self-Assessment,NationalLanguage Service Corp(NLSC) Global SkillsSelf-Assessment,NationalLanguage Service Corp(NLSC) Application
DD Form 2933,DD Form2934,DD Form 2932
4,500 1,218 $ 12,411
Agency: DOD/DODDEP OMB Control Number: 0704-0452Expiration Date: 02/28/2017 201401-0704-002Title: Project Time Record SystemICR AnnualResponses:62,400
ICR Annual Hours:15,600
ICR Annual Costs:$ 780,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostProject Time RecordSystem
62,400 15,600 $ 780,000
Agency: DOD/DODDEP OMB Control Number: 0704-0454Expiration Date: 09/30/2018 201508-0704-001Title: Defense Federal Acquisition Regulation Supplement; U.S. International Atomic Energy Agency Additional ProtocolICR AnnualResponses:300
ICR Annual Hours:300
ICR Annual Costs:$ 19,200
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 5527 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement; U.S.International AtomicEnergy AgencyAdditional Protocol
300 300 $ 19,200
Agency: DOD/DODDEP OMB Control Number: 0704-0455Expiration Date: 10/31/2016 201308-0704-010Title: Defense Biometric Identification System (DBIDS)ICR AnnualResponses:2,429,096
ICR Annual Hours:283,395
ICR Annual Costs:$ 3,340,393
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense BiometricIdentification System(DBIDS)
2,429,096 283,395 $ 3,340,393
Agency: DOD/DODDEP OMB Control Number: 0704-0457Expiration Date: 03/31/2019 201601-0704-002Title: Department of Defense Education Activity (DoDEA) Research Approval ProcessICR AnnualResponses:50
ICR Annual Hours:50
ICR Annual Costs:$ 2,521
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDepartment of DefenseEducation Activity(DoDEA) ResearchApproval Process
Research StudyRequest
DoDEA Form 2071.3-F1 50 50 $ 2,521
Agency: DOD/DODDEP OMB Control Number: 0704-0460Expiration Date: 08/31/2016 201306-0704-005Title: Synchronized Predeployment and Operational Tracker (SPOT) SystemICR AnnualResponses:300,000
ICR Annual Hours:150,000
ICR Annual Costs:$ 5,400,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostSynchronizedPredeployment andOperational Tracker(SPOT) System
300,000 150,000 $ 5,400,000
Agency: DOD/DODDEP OMB Control Number: 0704-0461Expiration Date: 09/30/2016 201307-0704-002Title: Qualification to Possess Firearms or AmmunitionICR AnnualResponses: ICR Annual Hours: ICR Annual Costs:
ICR Reference Number:
08/15/2016 11:11 AM 5528 of Detailed Current Inventory Report
Department of Defense
15,000 3,750 $ 148,500
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostQualification to PossessFirearms or Ammunition
15,000 3,750 $ 148,500
Agency: DOD/DODDEP OMB Control Number: 0704-0463Expiration Date: 01/31/2017 201311-0704-008Title: Application for Homeowners AssistanceICR AnnualResponses:17,000
ICR Annual Hours:17,000
ICR Annual Costs:$ 0
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostApplication forHomeowners Assistance
Application forHomeowners Assistance
DD Form 1607 17,000 17,000 $ 0
Agency: DOD/DODDEP OMB Control Number: 0704-0466Expiration Date: 07/31/2019 201606-0704-005Title: Science, Mathematics and Research for Transformation (SMART) Scholarship ProgramICR AnnualResponses:5,875
ICR Annual Hours:30,200
ICR Annual Costs:$ 218,950
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostScience, Mathematicsand Research forTransformation(SMART) ScholarshipProgram
SMART EducationalWork Plan,AwardLength ChangeApproval,Foreign TravelNotification,InternshipReport for RecruitmentParticipants,SMARTMediaRelease,ParticipantInformationVerification,Phase 1AnnualReport,RecruitmentInternshipRequest,RecruitmentSite VisitRequest,SMARTService AgreementAmendmentRequest,SMARTScholarship-for-ServiceProgram Service
SMARTScholarship,SMARTScholarship,SMARTScholarship,SMARTScholarship,SMARTScholarship,SMARTScholarship,SMARTScholarship,SMARTScholarship,SMARTScholarship,SMARTScholarship,SMARTScholarship,SMART
5,875 30,200 $ 218,950
Agency: DOD/DODDEP OMB Control Number: 0704-0470Expiration Date: 08/31/2016 201306-0704-003Title: MEPS Customer Satisfaction Survey
ICR Reference Number:
08/15/2016 11:11 AM 5529 of Detailed Current Inventory Report
Department of Defense
ICR AnnualResponses:122,000
ICR Annual Hours:20,333
ICR Annual Costs:$ 147,712
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostMEPS CustomerSatisfaction Survey
122,000 20,333 $ 147,712
Agency: DOD/DODDEP OMB Control Number: 0704-0472Expiration Date: 08/31/2016 201307-0704-006Title: Voice of Industry SurveyICR AnnualResponses:12,238
ICR Annual Hours:6,119
ICR Annual Costs:$ 210,861
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostVoice of Industry Survey 12,238 6,119 $ 210,861
Agency: DOD/DODDEP OMB Control Number: 0704-0477Expiration Date: 03/31/2017 201401-0704-004Title: Organizational Conflicts of Interest in Major Defense Acquisition ProgramsICR AnnualResponses:75
ICR Annual Hours:3,000
ICR Annual Costs:$ 306,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostOrganizational Conflictsof Interest in MajorDefense AcquisitionPrograms
75 3,000 $ 306,000
Agency: DOD/DODDEP OMB Control Number: 0704-0478Expiration Date: 07/31/2019 201603-0704-003Title: Safeguarding Covered Defense Information, Cyber Incident Reporting, and Cloud ComputingICR AnnualResponses:60,493
ICR Annual Hours:250,840
ICR Annual Costs:$ 16,053,494
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostSafeguarding CoveredDefense Information,Cyber IncidentReporting, and CloudComputing
60,493 250,840 $ 16,053,494
Agency: DOD/DODDEP OMB Control Number: 0704-0479Expiration Date: 09/30/2018 201506-0704-004Title: Defense Federal Acquisition Regulation Supplement (DFARS) Business Systems-Definition and Administration; DFARS
ICR Reference Number:
08/15/2016 11:11 AM 5530 of Detailed Current Inventory Report
Department of Defense
ICR AnnualResponses:12
ICR Annual Hours:8,112
ICR Annual Costs:$ 518,600
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense FederalAcquisition RegulationSupplement (DFARS)Business Systems-Definition andAdministration; DFARS234, Earned ValueManagement Systems
12 8,112 $ 518,600
Agency: DOD/DODDEP OMB Control Number: 0704-0481Expiration Date: 06/30/2017 201405-0704-001Title: Warranty Tracking of Serialized ItemsICR AnnualResponses:54,000
ICR Annual Hours:27,000
ICR Annual Costs:$ 1,014,660
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostWarranty Tracking ofSerialized Items
54,000 27,000 $ 1,014,660
Agency: DOD/DODDEP OMB Control Number: 0704-0482Expiration Date: 11/30/2018 201509-0704-003Title: Defense Sexual Assault Incident DatabaseICR AnnualResponses:1,130
ICR Annual Hours:1,313
ICR Annual Costs:$ 29,640
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense Sexual AssaultIncident Database
Defense Sexual AssaultIncident Database(DSAID) DataForm,Victim ReportingPreference Statement
DD 2965,DD 2910 1,130 1,313 $ 29,640
Agency: DOD/DODDEP OMB Control Number: 0704-0483Expiration Date: 03/31/2018 201412-0704-002Title: Independent Research and Development Technical DescriptionsICR AnnualResponses:26,950
ICR Annual Hours:13,475
ICR Annual Costs:$ 823,996
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostIndependent Researchand DevelopmentTechnical Descriptions
26,950 13,475 $ 823,996
08/15/2016 11:11 AM 5531 of Detailed Current Inventory Report
Department of Defense
Agency: DOD/DODDEP OMB Control Number: 0704-0485Expiration Date: 03/31/2017 201403-0704-009Title: Performance Based Payments (PBP) Analysis Tool; DFARS Part 232-Contract FinancingICR AnnualResponses:1,000
ICR Annual Hours:1,000
ICR Annual Costs:$ 64,040
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostPerformance BasedPayments (PBP)Analysis Tool; DFARSPart 232-ContractFinancing
1,000 1,000 $ 64,040
Agency: DOD/DODDEP OMB Control Number: 0704-0487Expiration Date: 05/31/2018 201503-0704-002Title: Certification of Qualified ProductsICR AnnualResponses:1,276
ICR Annual Hours:638
ICR Annual Costs:$ 15,950
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostCertification of QualifiedProducts
CERTIFICATION OFQUALIFIEDPRODUCTS
DD Form 1718 1,276 638 $ 15,950
Agency: DOD/DODDEP OMB Control Number: 0704-0489Expiration Date: 10/31/2016 201507-0704-001Title: Defense Industrial Base Cyber Security/Information Assurance (DIB CS/IA) Cyber Incident ReportingICR AnnualResponses:50,000
ICR Annual Hours:250,000
ICR Annual Costs:$ 10,255,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense Industrial BaseCyberSecurity/InformationAssurance (DIB CS/IA)Cyber IncidentReporting
50,000 250,000 $ 10,255,000
Agency: DOD/DODDEP OMB Control Number: 0704-0490Expiration Date: 11/30/2016 201508-0704-005Title: Defense Industrial Base Voluntary Cyber Security/Information Assurance (DIB CS/IA) Points of Contact (POC) InformationICR AnnualResponses:935
ICR Annual Hours:312
ICR Annual Costs:$ 11,984
ICR Reference Number:
08/15/2016 11:11 AM 5532 of Detailed Current Inventory Report
Department of Defense
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense Industrial BaseVoluntary CyberSecurity/InformationAssurance (DIB CS/IA)Points of Contact (POC)Information
935 312 $ 11,984
Agency: DOD/DODDEP OMB Control Number: 0704-0491Expiration Date: 09/30/2018 201505-0704-005Title: DoD Inventory of Contracts for Services ComplianceICR AnnualResponses:49,000
ICR Annual Hours:4,083
ICR Annual Costs:$ 980,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDoD Inventory ofContracts for ServicesCompliance
49,000 4,083 $ 980,000
Agency: DOD/DODDEP OMB Control Number: 0704-0494Expiration Date: 09/30/2016 201308-0704-004Title: Representations to Implement Appropriations Act Provisions on Felony Convictions and Unpaid Federal Tax LiabilitiesICR AnnualResponses:15,000
ICR Annual Hours:1,250
ICR Annual Costs:$ 64,800
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostRepresentations toImplementAppropriations ActProvisions on FelonyConvictions and UnpaidFederal Tax Liabilities
15,000 1,250 $ 64,800
Agency: DOD/DODDEP OMB Control Number: 0704-0497Expiration Date: 11/30/2017 201409-0704-006Title: DFARS Part 215 NegotiationICR AnnualResponses:160
ICR Annual Hours:640
ICR Annual Costs:$ 34,560
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDFARS Part 215Negotiation
160 640 $ 34,560
Agency: DOD/DODDEP OMB Control Number: 0704-0498Expiration Date: 08/31/2016 201305-0704-003ICR Reference Number:
08/15/2016 11:11 AM 5533 of Detailed Current Inventory Report
Department of Defense
Title: Confirmation of Request for Reasonable AccommodationICR AnnualResponses:20
ICR Annual Hours:5
ICR Annual Costs:$ 0
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostConfirmation of Requestfor ReasonableAccommodation
Confirmation of Requestfor ReasonableAccommodation
SD Form 827 20 5 $ 0
Agency: DOD/DODDEP OMB Control Number: 0704-0500Expiration Date: 07/31/2019 201606-0704-004Title: Vietnam War Commemoration Commemorative Planned EventsICR AnnualResponses:22,000
ICR Annual Hours:5,500
ICR Annual Costs:$ 272,360
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostVietnam WarCommemorationCommemorativePlanned Events
Vietnam WarCommemoration -Commemorative EventsRequest,Vietnam WarCommemorationCommemorativePlanned Events
DD Form 2956,DD 2956 0 0 $ 0
Vietnam WarComemmorationProgram Partner Events
Vietnam WarCommemorationCertificate of Honor: InMemory Of,Vietnam WarCommemoration After-Action Report,VietnamWar CommemorationCertificate of Honor:Former Vietnam WarPOW,Vietnam War 50thComemmorationCertificate of Honor:UnaccountedFor,Vietnam WarCommemorative EventsRequest
DD Form X711,DD Form2957,DD Form X712,DDForm X713,DD Form2956
22,000 5,500 $ 272,360
Agency: DOD/DODDEP OMB Control Number: 0704-0502Expiration Date: 05/31/2018 201504-0704-001Title: Federal Write-In Absentee Ballot (FWAB)ICR AnnualResponses:1,200,000
ICR Annual Hours:300,000
ICR Annual Costs:$ 6,381,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostFWAB Federal Write-in
Absentee Ballot (FWAB)Standard Form 186 1,200,000 300,000 $ 6,381,000
08/15/2016 11:11 AM 5534 of Detailed Current Inventory Report
Department of Defense
Agency: DOD/DODDEP OMB Control Number: 0704-0503Expiration Date: 05/31/2018 201504-0704-002Title: Federal Post Card Application (FPCA)ICR AnnualResponses:1,200,000
ICR Annual Hours:300,000
ICR Annual Costs:$ 6,381,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostFederal Post CardApplication (FPCA)
Voter Registration andAbsentee Ballot RequestFederal Post CardApplication (FPCA)
Standard Form 76 1,200,000 300,000 $ 6,381,000
Agency: DOD/DODDEP OMB Control Number: 0704-0504Expiration Date: 10/31/2016 201308-0704-007Title: National Geospatial-Intelligence Agency Enterprise Workforce SystemICR AnnualResponses:12,000
ICR Annual Hours:6,000
ICR Annual Costs:$ 233,520
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostEnterprise WorkforceSystem
12,000 6,000 $ 233,520
Agency: DOD/DODDEP OMB Control Number: 0704-0505Expiration Date: 12/31/2016 201310-0704-001Title: Boren Scholarship and Fellowship SurveyICR AnnualResponses:1,800
ICR Annual Hours:450
ICR Annual Costs:$ 16,830
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostBoren Scholarship andFellowship Survey
1,800 450 $ 16,830
Agency: DOD/DODDEP OMB Control Number: 0704-0506Expiration Date: 12/31/2016 201308-0704-001Title: How Differences in Pedagogical Methods Impact ChalleNGe Program OutcomesICR AnnualResponses:152
ICR Annual Hours:51
ICR Annual Costs:$ 1,014
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostHow Differences inPedagogicalMethodsImpact ChalleNGeProgram Outcomes
152 51 $ 1,014
08/15/2016 11:11 AM 5535 of Detailed Current Inventory Report
Department of Defense
Agency: DOD/DODDEP OMB Control Number: 0704-0507Expiration Date: 02/28/2017 201311-0704-002Title: Defense ReadyICR AnnualResponses:150
ICR Annual Hours:38
ICR Annual Costs:$ 950
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense Ready Security Screening
QuestionnaireWHCA Form 89 150 38 $ 950
Agency: DOD/DODDEP OMB Control Number: 0704-0508Expiration Date: 02/28/2017 201311-0704-004Title: Information Assurance Scholarship Program (IASP) SurveysICR AnnualResponses:493
ICR Annual Hours:123
ICR Annual Costs:$ 5,467
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostIASP Surveys 493 123 $ 5,467
Agency: DOD/DODDEP OMB Control Number: 0704-0509Expiration Date: 02/28/2017 201401-0704-001Title: Veteran's Community Reintegration Focus GroupsICR AnnualResponses:150
ICR Annual Hours:300
ICR Annual Costs:$ 4,875
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostVeteran's CommunityReintegration FocusGroups
150 300 $ 4,875
Agency: DOD/DODDEP OMB Control Number: 0704-0510Expiration Date: 04/30/2017 201403-0704-002Title: Physical Access Control System - G-BADGEICR AnnualResponses:10,000
ICR Annual Hours:2,500
ICR Annual Costs:$ 62,300
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostRequest for DLA Access 10,000 2,500 $ 62,300
Agency: DOD/DODDEP OMB Control Number: 0704-0511Expiration Date: 04/30/2017 201403-0704-003Title: Physical Access Control System - Diamond II
ICR Reference Number:
08/15/2016 11:11 AM 5536 of Detailed Current Inventory Report
Department of Defense
ICR AnnualResponses:15,000
ICR Annual Hours:3,750
ICR Annual Costs:$ 93,435
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostRequest for DLA Badge Request for DLA Badge DLA 1815 15,000 3,750 $ 93,435
Agency: DOD/DODDEP OMB Control Number: 0704-0512Expiration Date: 05/31/2017 201403-0704-005Title: Physical Access Control System - HoneywellICR AnnualResponses:25,000
ICR Annual Hours:6,250
ICR Annual Costs:$ 155,750
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostRequest for DLA Badge Request for DLA Badge DLA 1815 25,000 6,250 $ 155,750
Agency: DOD/DODDEP OMB Control Number: 0704-0513Expiration Date: 05/31/2017 201403-0704-006Title: Physical Access Control System - LenelICR AnnualResponses:60,000
ICR Annual Hours:15,000
ICR Annual Costs:$ 373,800
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostInstallation/FacilityAccess Control
Request for DLABadge,Contractor BadgeRequest,ID Card andKey Card Request,LocalAccess Badge Request
DLA 1815,DSCC 2310-1,DSCC 2310-2,DSCC2313
60,000 15,000 $ 373,800
Agency: DOD/DODDEP OMB Control Number: 0704-0514Expiration Date: 05/31/2017 201402-0704-001Title: Police Center Records (POLC)ICR AnnualResponses:220
ICR Annual Hours:110
ICR Annual Costs:$ 3,208
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostIncident ReportForm/System
Incident Report DLA 635 220 110 $ 3,208
Agency: DOD/DODDEP OMB Control Number: 0704-0515Expiration Date: 05/31/2017 201308-0704-008Title: DoD Child Development Program (CDP) - Background Investigations and Program RequestICR AnnualResponses: ICR Annual Hours: ICR Annual Costs:
ICR Reference Number:
08/15/2016 11:11 AM 5537 of Detailed Current Inventory Report
Department of Defense
5,000 833 $ 6,050
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostChild DeveoplmentForms
Application for DoDChild Care Fees,DoDChild DevelopmentProgram Request forCare Record
DD 2652,DD 2606 5,000 833 $ 6,050
Agency: DOD/DODDEP OMB Control Number: 0704-0516Expiration Date: 05/31/2017 201401-0704-005Title: DoD Child Development Program (CDP) - Criminal HistoryICR AnnualResponses:5,000
ICR Annual Hours:833
ICR Annual Costs:$ 6,050
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostForm and Instruction BASIC CRIMINAL
HISTORY ANDSTATEMENT OFADMISSION
DDX656 5,000 833 $ 6,050
Agency: DOD/DODDEP OMB Control Number: 0704-0517Expiration Date: 05/31/2017 201403-0704-008Title: 2014 Pentagon / Mark Center Transportation Commuter SurveyICR AnnualResponses:2,800
ICR Annual Hours:700
ICR Annual Costs:$ 23,982
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost2014 Pentagon / MarkCenter TransportationCommuter Survey
2,800 700 $ 23,982
Agency: DOD/DODDEP OMB Control Number: 0704-0520Expiration Date: 07/31/2017 201406-0704-003Title: Speak Up SurveyICR AnnualResponses:1,292
ICR Annual Hours:431
ICR Annual Costs:$ 8,484
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostSpeak Up Survey 1,292 431 $ 8,484
Agency: DOD/DODDEP OMB Control Number: 0704-0521Expiration Date: 07/31/2017 201404-0704-004Title: The Impact of ChalleNGe on Participants' Noncognitive Skills
ICR Reference Number:
08/15/2016 11:11 AM 5538 of Detailed Current Inventory Report
Department of Defense
ICR AnnualResponses:2,000
ICR Annual Hours:333
ICR Annual Costs:$ 2,422
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostChalleNGe CadetSurvey
2,000 333 $ 2,422
Agency: DOD/DODDEP OMB Control Number: 0704-0522Expiration Date: 07/31/2017 201406-0704-001Title: Computer Aided Dispatch and Records Management System (CAD/RMS)ICR AnnualResponses:693
ICR Annual Hours:231
ICR Annual Costs:$ 3,465
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostComputer AidedDispatch and RecordsManagement System(CAD/RMS)
693 231 $ 3,465
Agency: DOD/DODDEP OMB Control Number: 0704-0523Expiration Date: 07/31/2017 201405-0704-006Title: Assessing Options fro CONUS Domestic Dependents Elementary and Secondary Schools (DDESS)ICR AnnualResponses:28
ICR Annual Hours:56
ICR Annual Costs:$ 3,792
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostAssessing Options forCONUS DomesticDependents Elementaryand Secondary Schools(DDESS)
28 56 $ 3,792
Agency: DOD/DODDEP OMB Control Number: 0704-0524Expiration Date: 07/31/2017 201404-0704-005Title: 2014 Ethnographies and Focus GroupsICR AnnualResponses:475
ICR Annual Hours:871
ICR Annual Costs:$ 13,188
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost2014 Ethnographies andFocus Groups
475 871 $ 13,188
Agency: DOD/DODDEP OMB Control Number: 0704-0525Expiration Date: 01/31/2018 201411-0704-008ICR Reference Number:
08/15/2016 11:11 AM 5539 of Detailed Current Inventory Report
Department of Defense
Title: Foreign Commercial Satellite ServicesICR AnnualResponses:380
ICR Annual Hours:95
ICR Annual Costs:$ 4,275
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDFARS Clauses -Foreign CommercialSatellite Services
380 95 $ 4,275
Agency: DOD/DODDEP OMB Control Number: 0704-0526Expiration Date: 08/31/2017 201407-0704-003Title: DSS Commercial and Government Entity (CAGE) Code Request for InformationICR AnnualResponses:13,541
ICR Annual Hours:4,514
ICR Annual Costs:$ 156,591
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDSS Commercial andGovernment Entity(CAGE) Code Requestfor Information
13,541 4,514 $ 156,591
Agency: DOD/DODDEP OMB Control Number: 0704-0527Expiration Date: 09/30/2017 201407-0704-006Title: Research Performance Progress Report (RPPR)ICR AnnualResponses:4,000
ICR Annual Hours:24,000
ICR Annual Costs:$ 840,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostResearch PerformanceProgress Report (RPPR)
4,000 24,000 $ 840,000
Agency: DOD/DODDEP OMB Control Number: 0704-0528Expiration Date: 09/30/2017 201406-0704-005Title: Military OneSource Case Management System (CMS) - IntakeICR AnnualResponses:900,000
ICR Annual Hours:45,000
ICR Annual Costs:$ 759,150
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostCase ManagementIntake
900,000 45,000 $ 759,150
Agency: DOD/DODDEP OMB Control Number: 0704-0530Expiration Date: 10/31/2017 201409-0704-002ICR Reference Number:
08/15/2016 11:11 AM 5540 of Detailed Current Inventory Report
Department of Defense
Title: Global Air Transportation Execution System (GATES)ICR AnnualResponses:184,589
ICR Annual Hours:15,382
ICR Annual Costs:$ 583,301
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostGATES System 184,589 15,382 $ 583,301
Agency: DOD/DODDEP OMB Control Number: 0704-0531Expiration Date: 10/31/2017 201409-0704-001Title: Tender of Service for Personal Property Household Goods and Unaccompanied Baggage Shipments (DPS)ICR AnnualResponses:227,760
ICR Annual Hours:18,980
ICR Annual Costs:$ 294,190
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDD Form 619 Statement of
Accessorial ServicesPerformed
DD Form 619 227,760 18,980 $ 294,190
Agency: DOD/DODDEP OMB Control Number: 0704-0532Expiration Date: 11/30/2017 201410-0704-001Title: OFPP Rate the Agency InitiativeICR AnnualResponses:800
ICR Annual Hours:133
ICR Annual Costs:$ 10,640
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostOFPP Rate the AgencyInitiative
800 133 $ 10,640
Agency: DOD/DODDEP OMB Control Number: 0704-0533Expiration Date: 07/31/2018 201505-0704-001Title: Defense Federal Acquisition Regulation Supplement (DFARS) Part 249, Termination of Contracts, and a Related Clause atICR AnnualResponses:260
ICR Annual Hours:193
ICR Annual Costs:$ 10,422
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDFARS Clause 252.249-7002
260 193 $ 10,422
Agency: DOD/DODDEP OMB Control Number: 0704-0534Expiration Date: 08/31/2018 201505-0704-007Title: Defense Materiel Disposition Procedures for the Sale of DoD MaterielICR AnnualResponses: ICR Annual Hours: ICR Annual Costs:
ICR Reference Number:
08/15/2016 11:11 AM 5541 of Detailed Current Inventory Report
Department of Defense
189 236 $ 5,906
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense MaterielDisposition Forms
Pre-Award/Post AwardOn-SiteReview,Statement ofIntent,Sale ofGovernment Property -
DRMS 2006,DRMS1645,SF 114A
189 236 $ 5,906
Agency: DOD/DODDEP OMB Control Number: 0704-0535Expiration Date: 11/30/2017 201410-0704-003Title: Defense Acquisition University (DAU) Student Information System (SIS)ICR AnnualResponses:7,600
ICR Annual Hours:633
ICR Annual Costs:$ 18,269
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense AcquisitionUniverisity (DAU)Student InformationSystem (SIS)
7,600 633 $ 18,269
Agency: DOD/DODDEP OMB Control Number: 0704-0537Expiration Date: 02/28/2018 201501-0704-002Title: Joint Services Support (JSS) SystemICR AnnualResponses:12,000
ICR Annual Hours:2,000
ICR Annual Costs:$ 39,480
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostJoint Services Support(JSS) System
12,000 2,000 $ 39,480
Agency: DOD/DODDEP OMB Control Number: 0704-0538Expiration Date: 04/30/2018 201411-0704-010Title: Student and Parent Perception SurveysICR AnnualResponses:3,457
ICR Annual Hours:1,152
ICR Annual Costs:$ 36,209
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDoDEA Student andParent PerceptionSurveys
3,457 1,152 $ 36,209
Agency: DOD/DODDEP OMB Control Number: 0704-0539Expiration Date: 05/31/2018 201502-0704-008Title: Survey of Registered Voters Living Overseas
ICR Reference Number:
08/15/2016 11:11 AM 5542 of Detailed Current Inventory Report
Department of Defense
ICR AnnualResponses:18,000
ICR Annual Hours:3,000
ICR Annual Costs:$ 73,710
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostSurvey of RegisteredVoters Living Overseas
18,000 3,000 $ 73,710
Agency: DOD/DODDEP OMB Control Number: 0704-0542Expiration Date: 09/30/2018 201507-0704-004Title: Personnel Security System Access Request Form (PSSAR)ICR AnnualResponses:44,000
ICR Annual Hours:7,333
ICR Annual Costs:$ 117,330
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostPersonnel SecuritySystem Access RequestForm (PSSAR)
PERSONNELSECURITY SYSTEMACCESS REQUEST(PSSAR)
DD 2962 44,000 7,333 $ 117,330
Agency: DOD/DODDEP OMB Control Number: 0704-0545Expiration Date: 07/31/2019 201606-0704-001Title: Collection of Required Data Elements to Verify EligibilityICR AnnualResponses:1,000,000
ICR Annual Hours:80,000
ICR Annual Costs:$ 3,360,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostCollection of RequiredData Elements to VerifyEligibility
1,000,000 80,000 $ 3,360,000
Agency: DOD/DODDEP OMB Control Number: 0704-0546Expiration Date: 11/30/2018 201510-0704-001Title: Defense User Registration System (DURS) RecordsICR AnnualResponses:605
ICR Annual Hours:101
ICR Annual Costs:$ 3,140
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense UserRegistration System(DURS) Records
605 101 $ 3,140
Agency: DOD/DODDEP OMB Control Number: 0704-0547Expiration Date: 12/31/2018 201511-0704-002Title: AFNConnect (AFNC)
ICR Reference Number:
08/15/2016 11:11 AM 5543 of Detailed Current Inventory Report
Department of Defense
ICR AnnualResponses:700
ICR Annual Hours:117
ICR Annual Costs:$ 3,500
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostAFNConnect 700 117 $ 3,500
Agency: DOD/DODDEP OMB Control Number: 0704-0548Expiration Date: 12/31/2018 201511-0704-001Title: DISAM Information Technology Mission System (DISM)ICR AnnualResponses:9,800
ICR Annual Hours:2,450
ICR Annual Costs:$ 51,499
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDISAM InformationTechnology MissionSystem (DISM)
9,800 2,450 $ 51,499
Agency: DOD/DODDEP OMB Control Number: 0704-0550Expiration Date: 08/31/2016 201512-0704-007Title: Report on Voluntary Military Education Programs Advertising and MarketingICR AnnualResponses:10
ICR Annual Hours:240
ICR Annual Costs:$ 7,488
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostReport on VoluntaryMilitary EducationPrograms Advertisingand Marketing
10 240 $ 7,488
Agency: DOD/DODDEP OMB Control Number: 0704-0551Expiration Date: 02/28/2019 201601-0704-001Title: Office of the Secretary of Defense (OSD) Confidential Conflict-of-Interest Statement for Advisory Committee MembersICR AnnualResponses:125
ICR Annual Hours:125
ICR Annual Costs:$ 906
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostOffice of the Secretaryof Defense (OSD)Confidential Conflict-of-Interest Statement forAdvisory CommitteeMembers
Office of the Secretaryof Defense (OSD)Confidential Conflict-of-Interest Statement forAdvisory CommitteeMembers
SD Form X682 125 125 $ 906
Agency: DOD/DODDEP OMB Control Number: 0704-0552
08/15/2016 11:11 AM 5544 of Detailed Current Inventory Report
Department of Defense
Expiration Date: 02/28/2019 201602-0704-004Title: Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service DeliveryICR AnnualResponses:10,000
ICR Annual Hours:1,667
ICR Annual Costs:$ 37,240
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostFast Track GenericClearance for theCollection of QualitativeFeedback on AgencyService Delivery
0 0 $ 0
Agency: DOD/DODDEP OMB Control Number: 0704-0553Expiration Date: 04/30/2019 201512-0704-010Title: Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service DeliveryICR AnnualResponses:300,000
ICR Annual Hours:50,000
ICR Annual Costs:$ 1,135,500
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostState of StrategyConferenceQuestionnaire
25 4 $ 417
Three Rivers FeasibilityStudy NavigationClosure Survey
50 25 $ 189
Agency: DOD/DODDEP OMB Control Number: 0704-0555Expiration Date: 05/31/2019 201603-0704-005Title: Security Assistance Network (SAN)ICR AnnualResponses:43,980
ICR Annual Hours:10,995
ICR Annual Costs:$ 231,115
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostSecurity CooperationTraining ManagementSystem
43,980 10,995 $ 231,115
Agency: DOD/DODDEP OMB Control Number: 0704-0556Expiration Date: 08/31/2019 201606-0704-006Title: Spouse Education and Career Opportunities ProgramICR AnnualResponses:26,000
ICR Annual Hours:19,500
ICR Annual Costs:$ 452,920
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost
08/15/2016 11:11 AM 5545 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostSpouse Education andCarrer OpportunityProgram
26,000 19,500 $ 452,920
0704 DODDEP Totals:
Type # Information Collections Total Annual Responses Total Annual Hours Total Annual CostICR 125 26,756,109 39,501,811 $ 1,494,251,817
$ 000 0RCF26,756,109125 $ 1,494,251,817Total 39,501,811
Agency: DOD/COE OMB Control Number: 0710-0001Expiration Date: 08/31/2016 200704-0710-001Title: Corps of Engineers Civil Works Questionnaires Generic ClearanceICR AnnualResponses:185,500
ICR Annual Hours:17,307
ICR Annual Costs:$ 0
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostSurvey of Ohio RiverShippers
1,650 550 $ 0
Agency: DOD/COE OMB Control Number: 0710-0005Expiration Date: 01/31/2018 201411-0710-001Title: Record of Arrivals and Departures of Vessels at Marine TerminalsICR AnnualResponses:3,600
ICR Annual Hours:1,800
ICR Annual Costs:$ 34,236
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostVessel Operation Report Record of Arrivals and
Departures of Vesselsfor the Month of ____
ENG Form 3926 3,600 1,800 $ 34,236
Agency: DOD/COE OMB Control Number: 0710-0007Expiration Date: 03/31/2017 201401-0710-003Title: Terminal and Transfer Facilities DescriptionsICR AnnualResponses:1,262
ICR Annual Hours:313
ICR Annual Costs:$ 13,240
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostTerminal and TransferFacilities Descriptions
IWR Forms 1 through 9 1 through 9 1,262 313 $ 13,240
Agency: DOD/COE OMB Control Number: 0710-0008Expiration Date: 03/31/2017 201401-0710-002Title: Lock Performance Monitoring System (LPMS) Waterway Traffic Report
ICR Reference Number:
08/15/2016 11:11 AM 5546 of Detailed Current Inventory Report
Department of Defense
ICR AnnualResponses:607,197
ICR Annual Hours:26,312
ICR Annual Costs:$ 263,119
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostLock PerformanceMonitoring System(LPMS) Wateway TrafficReport
Waterway Traffic Report- Vessel Log,WaterwayTraffic Report - VesselLog
ENG Form 3102c,ENGForm 3102d
607,197 26,312 $ 263,119
Agency: DOD/COE OMB Control Number: 0710-0016Expiration Date: 12/31/2018 201606-0710-001Title: Hurricane Evacuation Behavioral SurveyICR AnnualResponses:40,000
ICR Annual Hours:10,000
ICR Annual Costs:$ 319,300
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual Cost2016 SoutheasternLouisiana HurricaneEvacuation Study
2,600 1,300 $ 0
Analyzing evacuationbehavior in New Jerseyto develop hurricaneevacuation andtransportation models
1,600 800 $ 12,768
Agency: DOD/COE OMB Control Number: 0710-0017Expiration Date: 04/30/2019 201509-0710-002Title: Flood Risk ManagementICR AnnualResponses:7,000
ICR Annual Hours:4,958
ICR Annual Costs:$ 159,658
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostFlood Risk ManagementSurvey
7,000 4,958 $ 159,658
Agency: DOD/COE OMB Control Number: 0596-0080Expiration Date: 12/31/2017 201509-0710-003CFTitle: Volunteer Application and Agreement for DoD Army Corp of Engineers VolunteersICR AnnualResponses:15,750
ICR Annual Hours:3,717
ICR Annual Costs:$ 0
Information Collections:
RCF ID:
Title Form Name Form Number Annual Responses Annual Hours Annual CostForm OF-301 VolunteerService Application-Natural & CulturalResources
Volunteer ServiceApplication for Natural &Cultural Resources
OF-301 250 63 $ 0
08/15/2016 11:11 AM 5547 of Detailed Current Inventory Report
Department of Defense
Title Form Name Form Number Annual Responses Annual Hours Annual CostForm OF-301aVolunteer ServiceAgreement- Natural &Cultural Resources
Volunteer ServiceAgreement -Spanish,VolunteerServiceAgreement,VolunterrService Agreement -
OF 301a,OF 301a,OF301a
12,500 3,125 $ 0
Form OF-301bVolunteer Sign-up Formfor Groups
Volunteer Sign-up Formfor Groups
OF 301b 1,000 30 $ 0
Volunteer.gov Website Volunteer ServiceApplication - Natural &Cultural Resources
OF-301 2,000 500 $ 0
0710 COE Totals:
Type # Information Collections Total Annual Responses Total Annual Hours Total Annual CostICR 6 844,559 60,690 $ 789,553
$ 03,7171 15,750RCF860,3097 $ 789,553Total 64,407
Agency: DOD/DODOASHA OMB Control Number: 0720-0003Expiration Date: 01/31/2019 201510-0720-002Title: Statement of Personal Injury - Possible Third Party Liability ChampusICR AnnualResponses:188,090
ICR Annual Hours:47,023
ICR Annual Costs:$ 400,632
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostStatement of PersonalInjury - Possible ThirdParty Liability Champus
Statement of PersonalInjury - Possible ThirdParty Liability
DD Form 2527,20150911
188,090 47,023 $ 400,632
Agency: DOD/DODOASHA OMB Control Number: 0720-0006Expiration Date: 08/31/2018 201501-0720-001Title: TRICARE DoD/CHAMPUS Medical Claim Patient's Request for Medical PaymentICR AnnualResponses:774,000
ICR Annual Hours:193,500
ICR Annual Costs:$ 4,992,300
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostTRICAREDoD/CHAMPUS MedicalClaim Patient's Requestfor Medical Payment
TRICAREDoD/CHAMPUS MedicalClaim Patient's Requestfor Medical Payment
DD From 2642 774,000 193,500 $ 4,992,300
Agency: DOD/DODOASHA OMB Control Number: 0720-0008Expiration Date: 05/31/2019 201602-0720-001Title: TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change FormICR AnnualResponses: ICR Annual Hours: ICR Annual Costs:
ICR Reference Number:
08/15/2016 11:11 AM 5548 of Detailed Current Inventory Report
Department of Defense
148,033 37,008 $ 268,310
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostTRICARE PrimeEnrollment,Disenrollment, andPrimary Care Manager(PCM) Change Form
TRICARE PrimeEnrollment,Disenrollment, andPrimary Care Manager(PCM) Change Form
DD 2876 148,033 37,008 $ 268,310
Agency: DOD/DODOASHA OMB Control Number: 0720-0017Expiration Date: 12/31/2018 201510-0720-001Title: Diagnosis Related Groups (DRG) Reimbursement (Two Parts)ICR AnnualResponses:5,600
ICR Annual Hours:8,400
ICR Annual Costs:$ 235,312
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDiagnosis RelatedGroups (DRG)Reimbursement (TwoParts)
5,600 8,400 $ 235,312
Agency: DOD/DODOASHA OMB Control Number: 0720-0020Expiration Date: 08/31/2019 201604-0720-001Title: Application for TRICARE-Provider Status: CORPORATE SERVICES PROVIDERICR AnnualResponses:300
ICR Annual Hours:100
ICR Annual Costs:$ 1,710
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostApplication forTRICARE-ProviderStatus: CORPORATESERVICES PROVIDER
Corporate ServicesProvider Application forTRICARE ProviderStatus
DD Form X644 300 100 $ 1,710
Agency: DOD/DODOASHA OMB Control Number: 0720-0022Expiration Date: 08/31/2016 201305-0720-001Title: DoD Active Duty/Reserve Forces Dental ExaminationICR AnnualResponses:712,500
ICR Annual Hours:35,625
ICR Annual Costs:$ 0
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDoD ActiveDuty/Reserve ForcesDental Examination
DoD ActiveDuty/Reserve ForcesDental Examination
DD Form 2813 712,500 35,625 $ 0
Agency: DOD/DODOASHA OMB Control Number: 0720-0028
08/15/2016 11:11 AM 5549 of Detailed Current Inventory Report
Department of Defense
Expiration Date: 02/28/2017 201309-0720-001Title: TRICARE Plus Enrollment Application TRICARE Plus Disenrollment RequestICR AnnualResponses:25,065
ICR Annual Hours:2,924
ICR Annual Costs:$ 75,446
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostTRICARE PlusEnrollment ApplicationTRICARE PlusDisenrollment Request
TRICARE PlusDisenrollmentForm,TRICARE PlusEnrollment Application
DD Form 2854,DD From2852
25,065 2,924 $ 75,446
Agency: DOD/DODOASHA OMB Control Number: 0720-0030Expiration Date: 09/30/2016 201307-0720-001Title: Women, Infants, and Children Overseas - Eligibility DeterminationICR AnnualResponses:31,672
ICR Annual Hours:7,918
ICR Annual Costs:$ 57,326
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostWomen, Infants, andChildren Overseas -Eligibility Determination
31,672 7,918 $ 57,326
Agency: DOD/DODOASHA OMB Control Number: 0720-0031Expiration Date: 11/30/2018 201507-0720-002Title: TRICARE: Standard Survey of Civilian ProvidersICR AnnualResponses:50,000
ICR Annual Hours:4,167
ICR Annual Costs:$ 120,000
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostTRICARE: StandardSurvey of CivilianProviders
50,000 4,167 $ 120,000
Agency: DOD/DODOASHA OMB Control Number: 0720-0032Expiration Date: 08/31/2019 201606-0720-001Title: Federal Agency Retail Pharmacy ProgramICR AnnualResponses:1,200
ICR Annual Hours:9,600
ICR Annual Costs:$ 403,968
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostFederal Agency RetailPharmacy Program
1,200 9,600 $ 403,968
Agency: DOD/DODOASHA OMB Control Number: 0720-0034
08/15/2016 11:11 AM 5550 of Detailed Current Inventory Report
Department of Defense
Expiration Date: 09/30/2018 201507-0720-003Title: Department of Defense (DoD) Patient Safety Culture SurveyICR AnnualResponses:14,022
ICR Annual Hours:2,337
ICR Annual Costs:$ 64,641
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDepartment of Defense(DoD) Patient SafetyCulture Survey
14,022 2,337 $ 64,641
Agency: DOD/DODOASHA OMB Control Number: 0720-0041Expiration Date: 12/31/2018 201509-0720-001Title: Defense Medical Human Resources System Internet (DMHRSi)ICR AnnualResponses:85,000
ICR Annual Hours:10,625
ICR Annual Costs:$ 293,250
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDefense Medical HumanResources SystemInternet (DMHRSi)
85,000 10,625 $ 293,250
Agency: DOD/DODOASHA OMB Control Number: 0720-0042Expiration Date: 02/28/2017 201312-0720-001Title: Researcher Responsibilities AcknowledgementICR AnnualResponses:89
ICR Annual Hours:45
ICR Annual Costs:$ 2,407
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostResearcherResponsibilitiesAcknowledgement
89 45 $ 2,407
Agency: DOD/DODOASHA OMB Control Number: 0720-0044Expiration Date: 02/28/2017 201311-0720-001Title: Certification of Non-Contributory TRICARE Supplement InsuranceICR AnnualResponses:1,500
ICR Annual Hours:250
ICR Annual Costs:$ 8,750
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostCertification of Non-Contributory TRICARESupplement Insurance
1,500 250 $ 8,750
Agency: DOD/DODOASHA OMB Control Number: 0720-0046
08/15/2016 11:11 AM 5551 of Detailed Current Inventory Report
Department of Defense
Expiration Date: 06/30/2017 201403-0720-001Title: Women, Infants and Children Overseas Participant Satisfaction SurveyICR AnnualResponses:150
ICR Annual Hours:38
ICR Annual Costs:$ 0
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostWomen, Infants andChildren OverseasParticipant SatisfactionSurvey
150 38 $ 0
Agency: DOD/DODOASHA OMB Control Number: 0720-0048Expiration Date: 09/30/2017 201404-0720-001Title: Award Fee Provider SurveyICR AnnualResponses:1,224
ICR Annual Hours:102
ICR Annual Costs:$ 2,942
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostAward Fee ProviderSurvey
1,224 102 $ 2,942
Agency: DOD/DODOASHA OMB Control Number: 0720-0049Expiration Date: 09/30/2018 201504-0720-001Title: TRICARE Young Adult ApplicationICR AnnualResponses:32,000
ICR Annual Hours:8,000
ICR Annual Costs:$ 0
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostTRICARE Young AdultApplication
TRICARE YOUNGADULT APPLICATION
DD 2947 32,000 8,000 $ 0
Agency: DOD/DODOASHA OMB Control Number: 0720-0055Expiration Date: 08/31/2019 201606-0720-003Title: Third Party Collection Program (Insurance Information)ICR AnnualResponses:5,850,000
ICR Annual Hours:390,000
ICR Annual Costs:$ 9,956,700
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostThird Party CollectionProgram (InsuranceInformation)
Third Party CollectionProgram/MedicalServices Account/OtherHealth Insurance
DD Form 2569 5,850,000 390,000 $ 9,956,700
Agency: DOD/DODOASHA OMB Control Number: 0720-0056
08/15/2016 11:11 AM 5552 of Detailed Current Inventory Report
Department of Defense
Expiration Date: 05/31/2018 201502-0720-001Title: Screening and Monitoring of DoD Personnel Deployed to Ebola Outbreak AreasICR AnnualResponses:2,400
ICR Annual Hours:480
ICR Annual Costs:$ 14,438
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostScreening andMonitoring of DoDPersonnel Deployed toEbola Outbreak Areas
Ebola Virus DeseaseExposure RiskEvlauation,Ebola VirusDisease RedeploymentRisk Assessment andMedical Clearance
DD Form 2990,DD Form2991
2,400 480 $ 14,438
Agency: DOD/DODOASHA OMB Control Number: 0720-0057Expiration Date: 01/31/2018 201404-0720-003Title: Enterprise Blood Management System (EBMS)ICR AnnualResponses:4,600
ICR Annual Hours:767
ICR Annual Costs:$ 12,806
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostEnterprise ManagementBlood System
4,600 767 $ 12,806
Agency: DOD/DODOASHA OMB Control Number: 0720-0058Expiration Date: 08/31/2019 201604-0720-002Title: Department of Defense Suicide Event Report (DoDSer)ICR AnnualResponses:1,375
ICR Annual Hours:229
ICR Annual Costs:$ 3,266
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDoDSER Suicide EventReport
1,375 229 $ 3,266
Agency: DOD/DODOASHA OMB Control Number: 0720-0059Expiration Date: 05/31/2018 201412-0720-001Title: Patient Centered Medical Home (PCMH) Staff Satisfaction SurveyICR AnnualResponses:3,105
ICR Annual Hours:518
ICR Annual Costs:$ 15,525
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostPatient CenteredMedical Home (PCMH)Staff Satisfaction Survey
3,105 518 $ 15,525
08/15/2016 11:11 AM 5553 of Detailed Current Inventory Report
Department of Defense
Agency: DOD/DODOASHA OMB Control Number: 0720-0060Expiration Date: 12/31/2018 201507-0720-001Title: Assistance Reporting Tool (ART)ICR AnnualResponses:169,606
ICR Annual Hours:42,402
ICR Annual Costs:$ 307,416
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostAssistance ReportingTool (ART)
169,606 42,402 $ 307,416
0720 DODOASHA Totals:
Type # Information Collections Total Annual Responses Total Annual Hours Total Annual CostICR 23 8,101,531 802,058 $ 17,237,145
$ 000 0RCF8,101,53123 $ 17,237,145Total 802,058
Agency: DOD/DFAS OMB Control Number: 0730-0002Expiration Date: 03/31/2017 201401-0730-002Title: Statement of Claimant Requesting Recertified CheckICR AnnualResponses:38,157
ICR Annual Hours:3,180
ICR Annual Costs:$ 47,382
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostStatement of ClaimantRequesting RecertifiedCheck
Statement of ClaimantRequestingReplacement Check
DD Form 2660 38,157 3,180 $ 47,382
Agency: DOD/DFAS OMB Control Number: 0730-0003Expiration Date: 03/31/2017 201401-0730-001Title: DFAS Customer Satisfaction Surveys--GenericICR AnnualResponses:219,300
ICR Annual Hours:21,739
ICR Annual Costs:$ 586,926
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDFAS CustomerSatisfaction Surveys--Generic
230,000 8,000 $ 0
DFAS Vendor payCustomer SatisfactionSurvey
25,100 3,347 $ 0
Agency: DOD/DFAS OMB Control Number: 0730-0008Expiration Date: 09/30/2016 201307-0730-001Title: Application for Former Spouse Payments from Retired PayICR AnnualResponses: ICR Annual Hours: ICR Annual Costs:
ICR Reference Number:
08/15/2016 11:11 AM 5554 of Detailed Current Inventory Report
Department of Defense
29,127 7,282 $ 164,276
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostApplication for FormerSpouse Payments fromRetired Pay
Application for FormerSpouse Payments FromRetired Pay
DD Form 2293 29,127 7,282 $ 164,276
Agency: DOD/DFAS OMB Control Number: 0730-0011Expiration Date: 08/31/2016 201306-0730-001Title: Physician Certificate for Child AnnuitantICR AnnualResponses:120
ICR Annual Hours:240
ICR Annual Costs:$ 0
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostPhysician Certificate forChild Annuitant
Physician Certificate forChild Annuitant
DD Form 2828 120 240 $ 0
Agency: DOD/DFAS OMB Control Number: 0730-0014Expiration Date: 07/31/2017 201406-0730-001Title: Dependency Statements: Parent, Child Born Out of Wedlock, Incapacitated Child Over Age 21, Full Time Student 21-22ICR AnnualResponses:20,969
ICR Annual Hours:17,474
ICR Annual Costs:$ 360,667
Information Collections:
ICR Reference Number:
Title Form Name Form Number Annual Responses Annual Hours Annual CostDependencyStatements: Parent,Child Born Out ofWedlock, IncapacitatedChild Over Age 21, FullTime Student 21-22Years of Age, and Wardof a Court
Dependency Statement- Full Time Student 21-22 Years ofAge,DependencyStatement - Ward ofCourt,DependencyStatement -Parent,DependencyStatement - Child BornOut Of Wedlock UnderAge 21,DependencyStatement -Incapacitated Child
DD Form 137-6,DD Form137-7,DD Form 137-3,DDForm 137-4,DD Form137-5
20,969 17,474 $ 360,667
0730 DFAS Totals:
Type # Information Collections Total Annual Responses Total Annual Hours Total Annual CostICR 5 307,673 49,915 $ 1,159,251
$ 000 0RCF307,6735 $ 1,159,251Total 49,915
Agency: DOD/OS OMB Control Number: 0790-0005Expiration Date: 11/30/2016 201309-0790-001Title: Informal DoD Review of Energy Projects
ICR Reference Number:
08/15/2016 11:11 AM 5555 of Detailed Current Inventory Report
Department of Defense
ICR AnnualResponses:5,678
ICR Annual Hours:5,678
ICR Annual Costs:$ 1,367,000
Information Collections:
Title Form Name Form Number Annual Responses Annual Hours Annual CostInformal DoD Review ofEnergy Projects
5,678 5,678 $ 1,367,000
0790 OS Totals:
Type # Information Collections Total Annual Responses Total Annual Hours Total Annual CostICR 1 5,678 5,678 $ 1,367,000
$ 000 0RCF5,6781 $ 1,367,000Total 5,678
0700 DOD Totals:
Type # Information Collections Total Annual Responses Total Annual Hours Total Annual CostICR 192 46,017,522 45,396,326 $ 1,634,325,820
$ 03,7171 15,750RCF46,033,272193 $ 1,634,325,820Total 45,400,043
