Uniformed Services Employment and Reemployment Rights Act (USERRA) Inquiry and Support Request

Forms and Documents

Document Name	Status
Form DD3201 Uniformed Services Employment and Reemployment Rights Act (USERRA) Inquiry Form	New
Supporting Statement Part A_0704-ERRA.docx Supporting Statement A	2023-12-21
DHRA-16 ICMS SORN 23 SEP 2020.pdf Supplementary Document	2023-12-11
ICMS Privacy Impact Assessment.pdf Supplementary Document	2023-12-11
USERRA Information Request DD Form 3021 Webpage.pdf Supplementary Document	2023-12-11
Agency Disclosure Notice 0704-ERRA.docx Supplementary Document	2023-12-05

IC Document Collections

IC ID	Document Title	Status
263806	Uniformed Services Employment and Reemployment Rights Act (USERRA) Inquiry Form	New

ICR Details

OMB Control No:	ICR Reference No: 202312-0704-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DOD/DODDEP	Agency Tracking No: 0704-ERRA
Title: Uniformed Services Employment and Reemployment Rights Act (USERRA) Inquiry and Support Request
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/21/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	977	0
Time Burden (Hours)	81	0
Cost Burden (Dollars)	2,117	0

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Abstract: This form is intended for those who are experiencing civilian employment problems related to military obligations and is needed to record information related to the mediation of disputes and answering of inquiries related to the USERRA; by tracking case assignments and mediation results of potential conflicts between employers and the National Guard, Reserves, or National Disaster Medical Service members they employ; and by reporting statistics related to the Employer Support of the Guard and Reserve (ESGR) Ombudsman Program in aggregate and at the state committee-level. These records are also used as a management tool for statistical analysis, tracking, reporting, evaluating program effectiveness and conducting research. Service members will request ESGR assistance as related to their rights and responsibilities pursuant to USERRA. Electronic form to be submitted through the www.ESGR.mil website, https://www.esgr.mil/​USERRA/​USERRA-Contact/​USERRA-Support-Request/​t/​1.

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Authorizing Statute(s): None

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:
	88 FR 30099	05/10/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 88378	12/21/2023
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
Uniformed Services Employment and Reemployment Rights Act (USERRA) Inquiry	DD3201	Uniformed Services Employment and Reemployment Rights Act Inquiry

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	977	0	0	977	0	0
Annual Time Burden (Hours)	81	0	0	81	0	0
Annual Cost Burden (Dollars)	2,117	0	0	2,117	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: This is a new collection with a new associated burden.

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Annual Cost to Federal Government: $80,370

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? No

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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: 12/21/2023

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