SUPPORTING STATEMENT
Title of Information Collection: Request for Medical Examination DD Form 2807-1/Report of Medical History DD Form 2807-2: 0704-0413
A. JUSTIFICATION
1. Need for Information Collection
Title 10 U.S. Codes, Sections 504, 505, 507, 532, 978, 1201, 1202, 4356, and EO 9397 require applicants to meet medical accession standards for enlistment, induction, and appointment to the Armed Forces. The DD Forms 2807-1, “Report of Medical History” and the DD Form 2807-2, “Medical Prescreen of Medical History Report” are designed to appropriately collect this information. Data are needed from applicants to elicit a more accurate picture of their well-being and medical history.
This information collected is the basis for determining medical eligibility of applicants for entry in the Armed Forces. This information is needed to determine the medical qualifications of applicants based upon their current and past medical history.
2. Use of Information
Applicants for initial entry into the Armed Forces and Service members requiring mandatory medical examinations, medical boards and other physical examination shall complete the DD Form 2807-1. All initial entry applicants required to complete a Chapter 2 physical examination will complete the DD Form 2807-2 prior to the medical examination. The purpose of this information is to gather the necessary initial data for determining the applicants’ medical eligibility and qualification for the Armed Forces and to establish the initial medical record.
The information obtained on the DD Form 2807-2 (applicant’s medical prescreen) ensures the recruiter that an applicant has identified any medical disqualifying condition(s) prior to application process and meets the Congressional requirements to obtain both the applicants Health Care provider and Insurance provider. Additionally, it allows the military examining physician to obtain medical records critical to evaluating the applicant’s medical condition(s) prior to their medical examination. The DD Form 2807-1 (medical history form), which goes into more detail than the DD Form 2807-2, is needed as part of the required medical examination to assist physicians in making determinations as to acceptability of applicants for military service and verifies disqualifying medical condition(s) noted on the prescreening form. Approximately 100,000 applicants will not meet the medical entry standards and will not require medical examination after completing the DD Form 2807-2 due to pre-existing medical conditions.
The DD Form 2807-1 may also be used by all Service members for retention and medical boards and other essential medical examinations as required by the Services.
The Military Services and the Coast Guard will use these data to evaluate applicants’ medical status in determining eligibility for enlistment, appointment or induction and to evaluate the entry standards for the Armed Forces. Data are also used to decrease premature medical discharges categorized as “Existing Prior to Service.” The DD Form 2807-2, “Medical Prescreen of Medical History Report,” will be completed by the recruiter, the applicant, and possibly a family member. It will be used to determine any disqualifying medical condition prior to physical examination and will be used to assist the physician in collecting medical information essential for completing the medical examination and determining the applicants’ qualification or disqualification. The DD Form 2807-1, “Report of Medical History,” is completed at the Military Entrance Processing Station by applicants and medical personnel. This information is collected and reviewed by physicians performing the entrance medical examination to determine the applicants’ eligibility. The information collected becomes part of the applicants’ medical records.
Improved Information Technology
The Department has determined that the DD Form 2807-1 and DD Form 2807-2 are appropriate for electronic generation. Recruiting stations able to use the form electronically will reduce the burden for not only the respondent, but for the recruiter as well. The forms are available on the DoD Electronic Forms Website in Fillable Adobe PDF files and used by the Military Entrance Processing Command (MEPCOM) Integrated Resource System (MIRS) at the Military Entrance Processing Stations (MEPS), the Department of Defense Medical Examination Review Board (DODMERB), and by the medical practitioners performing physical examinations.
MEPCOM is responsible for loading the DD Form 2807-1 and DD Form 2807-2 into the MEPCOM Integrated Resource System (MIRS) to enable respondents to electronically complete the form.
Currently the forms are printed to construct physical paper medical record for each applicant to carry to their training station. Strategic planning has led to research and development for ongoing initiatives, including biometrics, towards the creation of an electronic health record. Conceptually, these forms will be the genesis of the individual’s electronic health record. This improvement will lessen the burden on moving paper between agencies and will ensure better accuracy of data. Progress of this on-going initiative is contingent upon funding availability.
4. Efforts to Identify Duplication
The medical prescreen will identify medical conditions which are permanently disqualifying for applicants, stopping the recruiting process and decreasing medical cost and recruiters time. The duplication of data between the medical prescreen and the medical history form will allow MEPCOM to validate the data obtained from an applicant thus decreasing the incidence of conditions listed as existing prior to Service. It will allow the applicants to obtain medical records, prior to their medical examination, based upon their answers and their consent to release the medical records to the examining facility. This data will assist the practitioner in determining their qualification or disqualification for the Armed Services.
Data collected on the DD Form 2807-1 and DD Form 2807-2, provide a wide range of medical data needed to establish eligibility for enlistment, commissioning or appointment in the Armed Forces. No culmination of data from other sources would provide the necessary information for entrance.
5. Methods Used to Minimize Burden on Small Entities
Small businesses and other small entities will not be affected by this collection.
Consequences of Not Collecting the Information
Information is collected only once per applicant. If collection was stopped, ability to make determinations for enlistment, appointment or commissioning into the military would be hampered and the present and past medical status of the applicant could not be ascertained. Additionally, force readiness and health postures would be affected.
Special Circumstances
This collection of information is not conducted under special circumstances. This collection will be conducted in a manner consistent with guidelines contained in 5 CFR 1320.5 (d) (2).
Agency 60-Day Federal Register Notice and Consultations Outside the Agency
The 60-day Federal Register Notice announcing this information collection (as required by 5 CFR 1320.8(d)) was published in Vol. 79, No. 121, page 35729, on June 24, 2014. No public comments were received in response to the notice. This information collection was also reviewed by designated representatives from each Service Department Headquarters and Recruiting Commands with no comments.
This information collection was coordinated with officials from the Active and Reserve Military Services.
The 30-day Federal Register Notice was published in Vol. 79, No. 167, page 51,324, on August 28, 2014.
Payments to Respondents
No payments, gifts, or guarantees are made to respondents who provide this information.
Assurance of Confidentiality
Respondents are advised that statements will be held in strictest confidence and procedures are in place to protect the confidentiality of the information. The forms are maintained in personal records and are seen only by individuals who have a need to verify information contained on the form. The data will be secured to protect Personally Identifiable Information (PII) in accordance to DoD regulations. Records are maintained in secure, limited access, or monitored areas. Physical entry by unauthorized persons is restricted through the use of locks, passwords, or other administrative procedures. Access to personal information is limited to those individuals who require the records to perform their official assigned duties. The Privacy Act statement is contained on DD Forms 2807-1 and 2807-2.
Personal Identifying Information, Sensitive Questions, and Protection of the
Information
Personal Identifying Information (PII): Respondents are advised that their data are for OFFICIAL USE ONLY and will be maintained and used in strict confidence in accordance with Federal law and regulations and those procedures are in place to protect the confidentiality of the information. The electronic and paper forms will be secured to protect PII in accordance with DoD regulations. The erroneous release of PII might cause legal action from individuals against DoD and/or the government.
Protection of the Information: Records are maintained in secure, limited access, or monitored areas. Physical entry by unauthorized persons is restricted through the use of locks, passwords, or other administrative procedures. Access to personal information is limited to those individuals who require the records to perform their official assigned duties.
Character and social adjustment questions: The DD Form 2807-1 and DD Form 2807-2 include questions which may be considered sensitive in nature. These forms are the genesis for the personnel record, the medical record, and the security records. The Social Security Number (SSN) is obtained and stored into the initial record (personnel, finance, medical, and security) for proofing, vetting, and maintaining unambiguous person identity for U.S. persons. With the SSN being used for person identification in major DoD human resource systems (personnel, finance, and medical); it remains the only unique identifier that ensures accuracy across all the systems to ensure proper data retrieval. The Social Security Number is used to correctly identify the applicant through the accession process and to ensure the proper information is obtained from medical authorities. Questioning applicants solicits information which may not readily be divulged by applicants. Certain questions help reveal if there are congenital anomalies which are disqualifying for entrance into the military. Questions concerning family history may reveal a history of active disease(s) which would require additional reporting and precautionary procedures (i.e., drug and alcohol abuse, psychiatric treatment, or other medical conditions that would require additional evaluation). Any positive history of specific medical conditions may disqualify the applicant for entrance into the military service.
System of Records Notice SORNS: The following System of Records Notice (SORNs) oversees the collection of the PII for the DD Form 2807-1 and DD Form 2807-2. Completed form data is stored and maintained by USMEPCOM. Hardcopies are furnished to the Services. The DoD Blanket Routine Uses found at http://dpclo.defense.gov/privacy, apply to this collection. Applicable SORNs:
USMEPCOM: http://dpclo.defense.gov/Privacy/SORNsIndex/DODwideSORNArticleView/tabid/6797/Article/6811/a0601-270-usmepcom-dod.aspx U.S. Military Processing Command Integrated Resources System (USMIRS), (November 03, 2010, 75 FR 67700)
Estimates of Annual Response Burden and Labor Cost for Hour Burden to the
Respondent for Collection of Information.
Response Burden:
(1) DD Form 2807-2
Total annual respondents: 423,000
Frequency of response: 1
Total annual responses: 423,000
Burden per response: 10 minutes
Total burden hours: 70,500
(2) DD Form 2807-1
Total annual respondents: 350,000
Frequency of response: 1
Total annual responses: 350,000
Burden per response: 10 minutes
Total burden hours: 58,333
(3) Total Average Estimated Response Burden
Total Annual Responses: 773,000
Average Burden Per Response: 10 minutes
Total Annual Burden Hours: 128,833 hours
Explanation of How Burden was Estimated. An observed overall average of 10 minutes was taken to complete the DD Form 2807-1 and DD Form 2807-2.
Labor Cost to Respondents. There is a labor cost to the respondent to fill out these forms (DD Form 2807-1 and DD Form 2807-2).
DD Form 2807-1: 350,000 respondents at $7.25hr* at 10 min per form = $422,917.
DD Form 2807-2: 423,000 respondents at $7.25hr* at 10 min per form = $511,125.
Total labor cost to the respondents: $934,042
*Hourly rate based on U.S. Department of Labor federal minimum wage.
13. Estimates of Other Cost Burden for the Respondent for Collection of Information.
Total Capital and Start-up Cost. There is no capitol or set up cost associated with this information collection.
Operation and Maintenance Cost. There are no operational or maintenance costs associated with this information collection. The medical records from the medical providers during the initial entry process are paid for in accordance with their civilian fee for records; as a result we are not including operational cost for this process.
14. Estimates of Cost to the Federal Government.
a. Work load requirements.
Recruiter assists respondent with filling out each form. Estimated completion time is 10 minutes per form.
GS-06/Step 03 medical personnel review items to determine completeness of the responses. Estimated completion time is 5 minutes per form.
b. Estimated Costs of DD Form 2807-1and DD Form 2807-2 (pay based on CAPE Full Cost of Manpower Tool):
E-6 hourly pay = $36.90 at 10 mins (both forms) Cost = $6.15
GS-06/ Step 03 hourly pay = $31.84 at 5 mins (both forms) Cost = $2.65
Cost to the Federal Government per respondent $8.80
Total Cost for forms (773,000 x $8.80) $ 6,802,400
Cost for Medical Records (50,000 x $5.03 average) $294,600
Total DoD Cost $ 7,097,000
15. Changes in Burden.
Change in burden is reflected by a decrease of the Service recruiting mission. The number of applicants needed to fill positions in the Armed Services has been reduced in line with the overall military reduction.
The collection is being submitted as a revisions due to the reduction in burden but also because the Privacy Act Statement was revised on DD Form 2807-1, and both the Privacy Act Statement and the instructions were revised on DD Form 2807-2.
16. Publication Plans/Time Schedule.
Results of this information collection will not be published.
Approval Not to Display Expiration Date.
Approval not to display the expiration data is not being sought.
Exceptions to the Certification Statement.
No exceptions to the certification statement are being sought.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | The following are the headings for each question to be used in the Supporting Statement: |
| Author | OUSD PR |
| File Modified | 0000-00-00 |
| File Created | 2021-01-27 |