Pia

PRIVACY IMPACT ASSESSMENT (PIA)

For the

DoD Women, Infants, and Children Overseas Participant Information Management
System
TRICARE Management Activity (TMA)

SECTION 1: IS A PIA REQUIRED?
a. Will this Department of Defense (DoD) information system or electronic collection of
information (referred to as an "electronic collection" for the purpose of this form) collect,
maintain, use, and/or disseminate PII about members of the public, Federal personnel,
contractors or foreign nationals employed at U.S. military facilities internationally? Choose
one option from the choices below. (Choose (3) for foreign nationals).

D

(1) Yes, from members of the general public.

D

(2) Yes, from Federal personnel' and/or Federal contractors.

[8J (3) Yes, from both members of the general public and Federal personnel and/or Federal contractors.

D

(4) No

• "Federal personnel" are referred to in the 000 IT Portfolio Repository (DITPR) as "Federal employees."

b. If "No," ensure that DITPR or the authoritative database that updates DITPR is annotated
for the reason(s) why a PIA is not required. If the DoD information system or electronic
collection is not in DITPR, ensure that the reason(s) are recorded in appropriate
documentation.
c. If "Yes," then a PIA is required. Proceed to Section 2.

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SECTION 2: PIA SUMMARY INFORMATION

a. Why is this PIA being created or updated? Choose one:

o

New 000 Information System

~

Existing DoD Information System

o

o
o

New Electronic Collection
Existing Electronic Collection

Significantly Modified DoD Information

System

b. Is this 000 information system registered in the DITPR or the 000 Secret Internet Protocol
Router Network (SIPRNET) IT Registry?

o
o
~

Yes, DITPR

Enter DITPR System Identification Number

Yes, SIPRNET

Enter SIPRNET Identification Number

No

c. Does this DoD information system have an IT investment Unique Project Identifier (UPI), required
by section 53 of Office of Management and Budget (OMB) Circular A·11?

o

~

Yes

No

If "Yes," enter UPI

If unsure, consult the Component IT Budget Point of Contact to obtain the UPI.

d. Does this DoD information system or electronic collection require a Privacy Act System of
Records Notice (SORN)?
A Privacy Act SORN is required if the information system or electronic collection contains information about U.S. citizens
or lawful permanent U.S. residents that is [etrntved by name or other unique identifier. PIA and Privacy Act SORN
information should be consistent.

~

Yes

o

If "Yes," enter Privacy Act SORN Identifier

No
DHA10

000 Component-assigned designator, not the Federal Register number.

Consult the Component Privacy Office for additional information or

access 000 Privacy Act SORNs at: http://www.defenselink.millprivacyfnoticesf

or
Date of submission for approval to Defense Privacy Office

Consult the Component Privacy Office for this date.

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e. Does this DoD information system or electronic collection have an OMB Control Number?
Contact the Component Information Management Control Officer or DoD Clearance Officer for this information.
This number indicates OMS approval to collect data from 10 or more members of the public in a 12-month period
regardless of form or format.

[8J

Yes
Enter OMB Control Number

10720-0030

Enter Expiration Date

1-14_/3_o/_2_0_13_ _ _ _ _ _ _ _ _--1

~==========~----~

o

No

f. Authority to collect information. A Federal law, Executive Order of the President (EO), or DoD
requirement must authorize the collection and maintenance of a system of records.
(1) If this system has a Privacy Act SORN, the authorities in this PIA and the existing Privacy Act
SORN should be the same.
(2) Cite the authority for this DoD information system or electronic collection to collect, use, maintain
and/or disseminate PII. (If multiple authorities are cited, provide all that apply.)
(a) Whenever possible, cite the specific provisions of the statute and/or EO that authorizes
the operation of the system and the collection of PII.
(b) If a specific statute or EO does not exist, determine if an indirect statutory authority can
be cited. An indirect authority may be cited if the authority requires the operation or administration of
a program, the execution of which will require the collection and maintenance of a system of records.
(c) DoD Components can use their general statutory grants of authority ("internal
housekeeping") as the primary authority. The requirement, directive, or instruction implementing the
statute within the DoD Component should be identified.

10 U.S.C. 1060a, Special Supplemental Food Program; 42 U.S.C. Chapter 13A, Child Nutrition; 42 U.S.
C. §290-dd-2, Confidentiality of Records; 7 C.F.R. Part 246, Special Supplemental Nutrition; 45 C.F.R.
Parts 160 and 164, and E.O. 9397 (as amended, SSN).

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g. Summary of 000 information system or electronic collection. Answers to these questions
should be consistent with security guidelines for release of information to the public.
(1) Describe the purpose of this DoD information system or electronic collection and briefly
describe the types of personal information about individuals collected in the system.
000 is responsible for providing Women, Infants, and Children (WIC) benefits to eligible members of the
Armed Forces, civilian employees, and 000 contractors living overseas, and their family members. The
program provides eligible participants with supplemental nutritious food, nutrition counseling and education,
nutrition-health screening, and referrals to other health agencies.
The purpose of the WIC Overseas information system is to automate the processes used to determine
eligibility for the 000 WIC Overseas program and administer partiCipant benefits. The WIC Overseas
information system employs automated, physical, and system safeguards designed to ensure availability,
authentication, confidentiality, integrity, and non-repudiation.
Personally Identifiable Information (PII)/protected health information (PHI) collected by the WIC Overseas
information system includes name, date of birth, truncated Social Security Number (SSN), mailing address,
telecommunications numbers (e.g., mobile, fax, telephone), medical notes, E-mail address, military status
and/or records, and other personal data including household income, nutritional risk/medical data which
includes anthropometric (length or stature and weight), biochemical data (hematocrit or hemoglobin), and
dietary data (24-hour food recall). Medical history data includes such items as pregnancy history, food
allergies, medical conditions (i.e., asthma, diabetes, lactose intolerance, etc). The PI! collected pertains to
the following categories of individuals: members of the Armed Forces, civilian employees, and 000
contractors living overseas (or in a U.S. Territory or possession), and their family members who apply for
benefits in the 000 WIC Overseas program.
The system is owned by the TRICARE Management Activity (TMA) and operated by Women, Infants and
Children (WIC) Overseas, Choctaw Archiving Enterprise, 2161 Military Highway, Suite 214, San Antonio,
Texas 78213; telephone number (210) 341-3336.
WIC Overseas Program Manager
Choctaw Archiving Enterprise
2161 NW Military Hwy Suite 308
San Antonio, TX 78213
Ph. 210-341-3336 ext. 218
Toll free 877-267-3728
FAX 210-525-1398

(2) Briefly describe the privacy risks associated with the PI! collected and how these risks are
addressed to safeguard privacy.
The potential privacy risk regarding the collection, use, and/or sharing of PII/PHI by this system are identity theft
and disclosure of limited personal health information.
Administrative, physical and technical controls have been developed and implemented for the DoD Women,
Infants, and Children (WIC) Overseas Information System.
The WIC Overseas Information System is subject to the DoD Information Assurance Certification and Accreditation
Process (DIACAP) annually and has been found to maintain information assurance, PII protections, and security
postures consistent with those required under DoD Instruction 8510.01. The WIC Overseas Information System was
DIACAP certified and received Authorization to Operate on August 13, 2007. The most recent annual review was
completed on August 3, 2009.

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h. With whom will the PII be shared through data exchange, both within your DoD Component and
outside your Component (e.g., other DoD Components, Federal Agencies)? Indicate all that apply.

181

Within the DoD Component.
Specify.

0

ITMA or components within 000 as approved by TMA

Other 000 Components.

Specify.

0

Other Federal Agencies.

Specify.

181

State and Local Agencies.

Specify.

o

Women, Infants, and Children Program administered by state agencies
provided participant has authorized release.

Contractor (Enter name and describe the language in the contract that safeguards PII.)

Specify.

o

Other (e.g., commercial providers, colleges).

Specify.
i. Do individuals have the opportunity to object to the collection of their PII?

181

Yes

o

No

(1) If "Yes," describe method by which individuals can object to the collection of PI!.
Individuals can object to collection of PIl/PHI by not providing the required information during the application
process. A Privacy Act Statement is provided prior to completing an application for the WIC Overseas
Program.

(2) If "No," state the reason why individuals cannot object.

J.

Do individuals have the opportunity to consent to the specific uses of their PII?

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~

Yes

D

No

(1) If "Yes," describe the method by which individuals can give or withhold their consent.
Individuals are given the opportunity to consent to the uses of their PII/PHI during the application process.
Participants are also given the opportunity to consent to the release of their PIIIPHI to other WIC agencies by
means of the WIC Overseas Authorization to Release Information form. PIl/PHI is collected for permitted
uses and disclosures as set forth in DoD 602S.18-R, DoD Health Information Privacy Regulation. Individuals
are informed of these uses and are given the opportunity to restrict the use of their PIIIPHI based on the
procedures in place in accordance with DoD 602S.18-R, C10.1.

(2) If "No," state the reason why individuals cannot give or withhold their consent.

k. What information is provided to an Individual when asked to provide PII data? Indicate all that
apply.
~

Privacy Act Statement

D

Privacy Advisory

D

Other

D

None

Describe A Privacy Act Statement is provided to each applicant prior to applying for the WIC Overseas
each
Program. The Privacy Act Statement cites the authority, purpose, routine uses, and disclosure
applicable provisions for collecting Pit/PHI.
format.

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NOTE:

Sections 1 and 2 above are to be posted to the Component's Web site. Posting of these
Sections indicates that the PIA has been reviewed to ensure that appropriate safeguards are in
place to protect privacy.
A Component may restrict the publication of Sections 1 and/or 2 if they contain information that
would reveal sensitive information or raise security concerns.

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