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

Forms and Documents

Document Name	Status
Form DD Form X683 Application for Surrogate Association for DoD Self-Service (DS) Logon Form Form	Modified
SSN Justification_Component.pdf Supplementary Document	2018-07-27
SSN Justification_DPCLTD.pdf Supplementary Document	2018-07-27
SSN Justification for DEERS.pdf Supplementary Document	2018-07-27
0704-0559_SSA_7.27.2018.docx Supporting Statement A	2018-07-27
NOA.PDF Supplementary Document	2018-07-26
DEERS_PIA.PDF Supplementary Document	2016-10-06

IC Document Collections

IC ID	Document Title	Status
223842	Application for Surrogate Association for DoD Self-Service (DS) Logon Form Form	Modified

ICR Details

OMB Control No: 0704-0559	ICR Reference No: 201807-0704-005
Status: Active	Previous ICR Reference No: 201610-0704-002
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Application for Surrogate Association for DoD Self-Service (DS) Logon
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: 09/11/2018
	Date Received in OIRA: 07/27/2018
Terms of Clearance: The Department must report this collection in the Information Collection Budget.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2021	36 Months From Approved
Responses	5,000	0	0
Time Burden (Hours)	167	0	0
Cost Burden (Dollars)	9,870	0	0

---

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

---

Authorizing Statute(s): US Code: 10 USC 1044a Name of Law: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0790-AJ36	Final or interim final rulemaking	81 FR 76325	11/02/2016

---

Federal Register Notices & Comments
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 35625	07/27/2018
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Application for Surrogate Association for DoD Self-Service (DS) Logon Form	DD Form X683	Application for Surrogate Association for DoD Self-Service (DS) Logon

---

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	5,000	0	0	5,000	0	0
Annual Time Burden (Hours)	167	0	0	167	0	0
Annual Cost Burden (Dollars)	9,870	0	0	9,870	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: There are no changes in burden as this is a new collection. OMB had previously issued a comment on the rule, which generated the OMB Control Number.

---

Annual Cost to Federal Government: $4,109

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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]? No

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

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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

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

(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: 07/27/2018

---