Consent to Release Personal Information

Forms and Documents

Document Name	Status
Form OPNAV 1770/3 OPNAV 1770/3 Next of Kin Identification Form	New
Form OPNAV 1770/2 OPNAV 1770/2 Next of Kin Travel Request Form	New
Form OPNAV 1770/1 OPNAV 1770/1 Consent to Release Personal Information Form	New
0703-AALN_SS-A_11.15.19.docx Supporting Statement A	2019-11-15
SECNAV 5213 1forOPNAV1770 3(2019)signed.pdf Supplementary Document	2019-11-15
SECNAV 5213 1forOPNAV1770 2(2019)signed.pdf Supplementary Document	2019-11-15

IC Document Collections

IC ID	Document Title	Status
238578	OPNAV 1770/3 Next of Kin Identification Form	New
238577	OPNAV 1770/2 Next of Kin Travel Request Form	New
238576	OPNAV 1770/1 Consent to Release Personal Information Form	New

ICR Details

OMB Control No: 0703-0076	ICR Reference No: 201911-0703-003
Status: Active	Previous ICR Reference No:
Agency/Subagency: DOD/NAVY	Agency Tracking No: 0703-AALN
Title: Consent to Release Personal Information
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/16/2019
	Date Received in OIRA: 11/15/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2022	36 Months From Approved
Responses	2,000	0	0
Time Burden (Hours)	1,300	0	0
Cost Burden (Dollars)	34,054	0	0

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Abstract: Provide Congressional offices with contact information for next of kin of deceased Sailors (upon consent); provide personal information to Defense Finance and Accounting Service (DFAS) for benefits payments; collect information to secure travel entitlements using the Defense Travel System (DTS).

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Authorizing Statute(s): US Code: 38 USC 1965-1980 Name of Law: Service Members’ Group Life Insurance
   US Code: 10 USC 1475 Name of Law: Death Gratuity
   US Code: 37 USC 481f Name of Law: Travel for funeral attendance
   US Code: 47 USC 481h Name of Law: Travel for bedside attendance (for qualifying ill/injured)
   US Code: 10 USC 1447-1455 Name of Law: Survivor Benefit Plan
  

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:
	84 FR 30101	06/26/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 62517	11/15/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
OPNAV 1770/3 Next of Kin Identification	OPNAV 1770/3	Next of Kin Identification
OPNAV 1770/1 Consent to Release Personal Information	OPNAV 1770/1	Consent to Release Personal Information
OPNAV 1770/2 Next of Kin Travel Request	OPNAV 1770/2	Next of Kin Travel Request

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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	2,000	0	0	2,000	0	0
Annual Time Burden (Hours)	1,300	0	0	1,300	0	0
Annual Cost Burden (Dollars)	34,054	0	0	34,054	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: $40,635

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

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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: 11/15/2019

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