Request for Examination

Forms and Documents

Document Name	Status
Form 680-3A-E Request for Examination Form	Modified
USMEPCOM 680-3 Supporting Supporting Statement.doc Supporting Statement A	2010-03-24
System of Record - (A0601-270 USMEPCOM DoD) USMEPCOM FORM 680-3A-E.doc Supplementary Document	2009-07-27

IC Document Collections

IC ID	Document Title	Status
190096	Request for Examination Form	Modified

ICR Details

OMB Control No: 0704-0468	ICR Reference No: 201003-0704-009
Status: Historical Active	Previous ICR Reference No: 200907-0704-001
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Request for Examination
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/02/2010
	Date Received in OIRA: 03/24/2010
Terms of Clearance: DOD must come back to OMB with a revised set of forms based on comments provided to the Department on March 31, 2010.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2011	36 Months From Approved
Responses	850,000	0	0
Time Burden (Hours)	141,950	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this information collection is to gather the necessary verifiable information for determining eligibility to process, qualify and join the Armed Forces and for establishing personal records on those enlisting. USMEPCOM Form 680-3A-E “Request for Examination” is the form associated with this information collection.

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Authorizing Statute(s): US Code: 10 USC 504 Name of Law: null
   US Code: 10 USC 505 Name of Law: null
   US Code: 10 USC 508 Name of Law: null
   US Code: 10 USC 12102 Name of Law: null
   US Code: 14 USC 351 Name of Law: null
   US Code: 14 USC 632 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 53208	09/15/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 38423	08/03/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Request for Examination	680-3A-E	Request for Examination

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	850,000	0	0	850,000	0	0
Annual Time Burden (Hours)	141,950	0	0	141,950	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Existing collection without OMB number.

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Annual Cost to Federal Government: $2,635,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/24/2010

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