81 FR 4266 - Proposed Collection; Comment Request

DEPARTMENT OF DEFENSE
Office of the Secretary

Federal Register Volume 81, Issue 16 (January 26, 2016)

Page Range		4266-4267
FR Document		2016-01481

In compliance with the Paperwork Reduction Act of 1995, the Office of the Under Secretary of Defense (Personnel and Readiness) announces a proposed public information collection and seeks public comment on the provisions thereof. Comments are invited on: (a) Whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; (b) the accuracy of the agency's estimate of the burden of the proposed information collection; (c) ways to enhance the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the information collection on respondents, including through the use of automated collection techniques or other forms of information technology.

Federal Register, Volume 81 Issue 16 (Tuesday, January 26, 2016)

[Federal Register Volume 81, Number 16 (Tuesday, January 26, 2016)]
[Notices]
[Pages 4266-4267]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-01481]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID: DoD-2016-OS-0005]


Proposed Collection; Comment Request

AGENCY: Office of the Under Secretary of Defense (Personnel and 
Readiness), DoD.

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act of 1995, the 
Office of the Under Secretary of Defense (Personnel and Readiness) 
announces a proposed public information collection and seeks public 
comment on the provisions thereof. Comments are invited on: (a) Whether 
the proposed collection of information is necessary for the proper 
performance of the functions of the agency, including whether the 
information shall have practical utility; (b) the accuracy of the 
agency's estimate of the burden of the proposed information collection; 
(c) ways to enhance the quality, utility, and clarity of the 
information to be collected; and (d) ways to minimize the burden of the 
information collection on respondents, including through the use of 
automated collection techniques or other forms of information 
technology.

DATES: Consideration will be given to all comments received by March 
28, 2016.

ADDRESSES: You may submit comments, identified by docket number and 
title, by any of the following methods:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
     Mail: Department of Defense, Office of the Deputy Chief 
Management Officer, Directorate of Oversight and Compliance, Regulatory 
and Audit Matters Office, 9010 Defense Pentagon, Washington, DC 20301-
9010.
    Instructions: All submissions received must include the agency 
name, docket number and title for this Federal

[[Page 4267]]

Register document. The general policy for comments and other 
submissions from members of the public is to make these submissions 
available for public viewing on the Internet at http://www.regulations.gov as they are received without change, including any 
personal identifiers or contact information.
    Any associated form(s) for this collection may be located within 
this same electronic docket and downloaded for review/testing. Follow 
the instructions at http://www.regulations.gov for submitting comments. 
Please submit comments on any given form identified by docket number, 
form number, and title.

FOR FURTHER INFORMATION CONTACT: To request more information on this 
proposed information collection or to obtain a copy of the proposal and 
associated collection instruments, please write to the Office of the 
Under Secretary of Defense (Personnel and Readiness) (Military 
Community and Family Policy) Office of Family Readiness Policy, Special 
Needs Program, ATTN: Rebecca Lombardi, 4000 Defense Pentagon, 
Washington, DC 20301-4000 or call 571-372-0862.

SUPPLEMENTARY INFORMATION:
    Title; Associated Form; and OMB Number: Family Member Travel 
Screening, DD Form X678-1TEST, Medical and Education Information, DD 
Form X678-2TEST, Dental Health Information, and DD Form X678-3TEST, 
Patient Care Review, OMB Control Number 0704-XXXX.
    Needs and Uses: The DD Forms X678-1 TEST, X678-2 TEST, and X678-3 
TEST are to be used during the Family Member Travel Screening (FMTS) 
process when active duty Service members with Permanent Change of 
Station (PCS) orders to OCONUS or remote installations request Command 
sponsorship for accompanied travel. These forms assist in determining 
the availability of care at a gaining installation by documenting any 
special medical, dental, and/or educational needs of dependents 
accompanying the Service member. Throughout the process, form 
respondents include: (1) Active duty Service members and/or dependents 
over the age of majority who provide demographic information; (2) 
medical and dental providers who provide information about dependent 
medical and dental needs; (3) losing FMTS Office staff who document any 
special medical, dental, and/or educational needs; and (4) gaining FMTS 
Office staff who document the availability of special needs support 
services at a gaining location.
    Affected Public: Individuals or households; medical and dental 
providers.
    Annual Burden Hours: 2,899 hours.
    Number of Respondents: 9,876 respondents.
    Responses per Respondent: 1 per year.
    Annual Responses: 9,876 per year.
    Average Burden per Response: 18 minutes.
    Frequency: As needed.
    The following is a breakdown of the public time burden for specific 
FMTS Pilot forms:
     The DD Form X678-1 TEST Medical and Educational 
Information informs sponsors and FMTS staff about possible special 
medical and/or educational needs of each dependent and guides the 
appropriate record review and the face-to-face interview. This form is 
completed by Service members and/or family members and internal 
physicians.
    [cir] Total annual public time burden for the DD Form X678-1 TEST: 
1,573 hours.
    [cir] Average time per response for the DD Form X678-1 TEST (in 
minutes): 20 minutes.
    [cir] Total annual public cost burden for the DD Form X678-1 TEST: 
$35,714.
     The DD Form X678-2 TEST Dental Health Information 
documents the dental health of dependent(s) in preparation for a move 
to a location where the patient may have limited access to dental care. 
This form is completed by Service members and/or family members and 
internal or civilian dentists.
    [cir] Total annual public time burden for the DD Form X678-2 TEST: 
698 hours.
    [cir] Average time per response for the DD Form X678-2 TEST (in 
minutes): 6 minutes.
    [cir] Total annual public cost burden for the DD Form X678-2 TEST: 
$49,218.
     The DD Form X678-3 TEST Patient Care Review summarizes 
each dependent's medical care received outside the Military Treatment 
Facility (MTF) (completed by non-MTF primary care managers). If 
applicable, this form is completed by Service members and/or family 
members and civilian physicians.
    [cir] Total annual public time burden for the DD Form X678-3 TEST: 
629 hours.
    [cir] Average time per response for the DD Form X678-3 TEST (in 
minutes): 8 minutes.
    [cir] Total annual public cost burden for the DD Form X678-3 TEST: 
$53,081.
    The DD TEST Forms will be piloted to test a standardized FMTS 
process across the military medical departments. The pilot will 
determine how the TEST forms can integrate into Service-specific 
assignment processes. If the forms can successfully integrate into 
these processes, then these TEST forms will be implemented as DD Forms. 
For a period of 90 days, the DD TEST Forms will be used in place of 
existing Service-specific FMTS forms for military families accompanying 
a Service member from a participating losing installation to a 
participating gaining installation. These TEST Forms will be monitored 
until the travel screening processes for all participating families are 
complete. During the pilot, military medical departments at 
participating installations will continue to screen non-pilot families 
using the current military medical department travel screening 
processes and forms.

    Dated: January 21, 2016.
Aaron Siegel,
Alternate OSD Federal Register, Liaison Officer, Department of Defense.
[FR Doc. 2016-01481 Filed 1-25-16; 8:45 am]
BILLING CODE 5001-06-P

Federal Register / Vol. 81, No. 16 / Tuesday, January 26, 2016 / Notices 4267

Register document. The general policy Affected Public: Individuals or Service-specific assignment processes. If
for comments and other submissions households; medical and dental the forms can successfully integrate into
from members of the public is to make providers. these processes, then these TEST forms
these submissions available for public Annual Burden Hours: 2,899 hours. will be implemented as DD Forms. For
viewing on the Internet at http:// Number of Respondents: 9,876 a period of 90 days, the DD TEST Forms
www.regulations.gov as they are respondents. will be used in place of existing Service-
received without change, including any Responses per Respondent: 1 per year. specific FMTS forms for military
personal identifiers or contact Annual Responses: 9,876 per year. families accompanying a Service
information. Average Burden per Response: 18 member from a participating losing
Any associated form(s) for this minutes. installation to a participating gaining
collection may be located within this Frequency: As needed. installation. These TEST Forms will be
same electronic docket and downloaded The following is a breakdown of the monitored until the travel screening
for review/testing. Follow the public time burden for specific FMTS processes for all participating families
instructions at http:// Pilot forms: are complete. During the pilot, military
www.regulations.gov for submitting • The DD Form X678–1 TEST medical departments at participating
comments. Please submit comments on Medical and Educational Information installations will continue to screen
any given form identified by docket informs sponsors and FMTS staff about non-pilot families using the current
number, form number, and title. possible special medical and/or military medical department travel
FOR FURTHER INFORMATION CONTACT: To
educational needs of each dependent screening processes and forms.
request more information on this and guides the appropriate record
review and the face-to-face interview. Dated: January 21, 2016.
proposed information collection or to Aaron Siegel,
obtain a copy of the proposal and This form is completed by Service
members and/or family members and Alternate OSD Federal Register, Liaison
associated collection instruments, Officer, Department of Defense.
please write to the Office of the Under internal physicians.
Æ Total annual public time burden for [FR Doc. 2016–01481 Filed 1–25–16; 8:45 am]
Secretary of Defense (Personnel and
the DD Form X678–1 TEST: 1,573 BILLING CODE 5001–06–P
Readiness) (Military Community and
hours.
Family Policy) Office of Family
Æ Average time per response for the
Readiness Policy, Special Needs
DD Form X678–1 TEST (in minutes): 20 ELECTION ASSISTANCE COMMISSION
Program, ATTN: Rebecca Lombardi,
minutes.
4000 Defense Pentagon, Washington, DC Æ Total annual public cost burden for Sunshine Act Notice
20301–4000 or call 571–372–0862. the DD Form X678–1 TEST: $35,714.
AGENCY: U.S. Election Assistance
SUPPLEMENTARY INFORMATION: • The DD Form X678–2 TEST Dental
Title; Associated Form; and OMB Commission.
Health Information documents the
Number: Family Member Travel dental health of dependent(s) in ACTION: Public Meeting of the Technical
Screening, DD Form X678–1TEST, preparation for a move to a location Guidelines Development Committee.
Medical and Education Information, DD where the patient may have limited
Form X678–2TEST, Dental Health SUMMARY: The Technical Guidelines
access to dental care. This form is Development Committee (TGDC) will
Information, and DD Form X678– completed by Service members and/or
3TEST, Patient Care Review, OMB meet in open session on Monday,
family members and internal or civilian February 8, 2016 and Tuesday, February
Control Number 0704–XXXX. dentists.
Needs and Uses: The DD Forms 9, 2016 at the U.S. Access Board in
Æ Total annual public time burden for Washington, DC.
X678–1 TEST, X678–2 TEST, and the DD Form X678–2 TEST: 698 hours.
X678–3 TEST are to be used during the DATES: The meeting will be held on
Æ Average time per response for the
Family Member Travel Screening Monday, February 8, 2016, from 8:30
DD Form X678–2 TEST (in minutes): 6
(FMTS) process when active duty a.m. until 5:00 p.m., Eastern time
minutes.
Service members with Permanent Æ Total annual public cost burden for (estimated based on speed of business),
Change of Station (PCS) orders to the DD Form X678–2 TEST: $49,218. and Tuesday, February 9, 2016 from
OCONUS or remote installations request • The DD Form X678–3 TEST Patient 8:30 a.m. to 3:15 p.m., Eastern time
Command sponsorship for accompanied Care Review summarizes each (estimated based on speed of business).
travel. These forms assist in determining dependent’s medical care received ADDRESSES: The meeting will take place
the availability of care at a gaining outside the Military Treatment Facility at the U.S. Access Board, 1331 F Street
installation by documenting any special (MTF) (completed by non-MTF primary NW., Suite 800, Washington, DC 20004–
medical, dental, and/or educational care managers). If applicable, this form 1111; (202) 272–0080.
needs of dependents accompanying the is completed by Service members and/ FOR FURTHER INFORMATION CONTACT:
Service member. Throughout the or family members and civilian Patricia Wilburg, NIST Voting Program,
process, form respondents include: (1) physicians. Information Technology Laboratory,
Active duty Service members and/or Æ Total annual public time burden for National Institute of Standards and
dependents over the age of majority who the DD Form X678–3 TEST: 629 hours. Technology, 100 Bureau Drive, Stop
provide demographic information; (2) Æ Average time per response for the 8970, Gaithersburg, MD 20899–8930,
medical and dental providers who DD Form X678–3 TEST (in minutes): 8 telephone: (301) 975–6994 or
mstockstill on DSK4VPTVN1PROD with NOTICES

provide information about dependent minutes. patricia.wilburg@nist.gov.
medical and dental needs; (3) losing Æ Total annual public cost burden for Agenda Information: Pursuant to the
FMTS Office staff who document any the DD Form X678–3 TEST: $53,081. Federal Advisory Committee Act
special medical, dental, and/or The DD TEST Forms will be piloted (FACA), 5 U.S.C.A. App. 2, notice is
educational needs; and (4) gaining to test a standardized FMTS process hereby given that the TGDC will meet
FMTS Office staff who document the across the military medical Monday, February 8, 2016, from 8:30
availability of special needs support departments. The pilot will determine a.m. until 5:00 p.m., Eastern time, and
services at a gaining location. how the TEST forms can integrate into Tuesday, February 9, 2016 from 8:30

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Document Created: 2018-02-02 12:38:05
Document Modified: 2018-02-02 12:38:05

Category		Regulatory Information
Collection		Federal Register
sudoc Class		AE 2.7: GS 4.107: AE 2.106:
Publisher		Office of the Federal Register, National Archives and Records Administration
Section		Notices
Action		Notice.
Dates		Consideration will be given to all comments received by March 28, 2016.
Contact		To request more information on this proposed information collection or to obtain a copy of the proposal and associated collection instruments, please write to the Office of the Under Secretary of Defense (Personnel and Readiness) (Military Community and Family Policy) Office of Family Readiness Policy, Special Needs Program, ATTN: Rebecca Lombardi, 4000 Defense Pentagon, Washington, DC 20301-4000 or call 571-372-0862.
FR Citation		81 FR 4266

81 FR 4266 - Proposed Collection; Comment Request

DEPARTMENT OF DEFENSEOffice of the Secretary

Federal Register Volume 81, Issue 16 (January 26, 2016)

DEPARTMENT OF DEFENSE
Office of the Secretary