Specific Authorization for Disclosure of Financial Information (DCSA 343) and Specific Authorization for Release of Behavioral Health and Related Medical Information (DCSA 344)

Forms and Documents

Document Name	Status
Form DCSA 343 DCS 343 and 344: Specific Authorization for Disclosure of Financial Information and Specific Authorization for Release of Behavioral Health and Related Medical Information Form and Instruction	New
343-344_SSNJ_Memo.pdf Supplementary Document	2025-12-02
0705-SARD_SSA_12.16.25.docx Supporting Statement A	2025-12-16

IC Document Collections

IC ID	Document Title	Status
275615	DCS 343 and 344: Specific Authorization for Disclosure of Financial Information and Specific Authorization for Release of Behavioral Health and Related Medical Information Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202506-0705-002
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DOD/OUSDI	Agency Tracking No: 0705-SARD
Title: Specific Authorization for Disclosure of Financial Information (DCSA 343) and Specific Authorization for Release of Behavioral Health and Related Medical Information (DCSA 344)
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: 12/16/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	3,563	0
Time Burden (Hours)	297	0
Cost Burden (Dollars)	18,121	0

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Abstract: The information collected on the 343 and 344 is used for Federal and Federal contract employment that allows consent for DCSA to access certain financial and medical records which are protected under the provisions of the Right to Financial Privacy Act and the Health Insurance Portability and Accountability Act.

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Authorizing Statute(s): EO: EO 13467 Name/Subject of EO: Reforming Processes Related to Suitability for Government Employment, Fitness for Contractor Employe
   EO: EO 13869 Name/Subject of EO: Transferring Responsibility for Background Investigations to the Department of Defense
   PL: Pub.L. 115 - 91 925 Name of Law: Background and security investigations for Department of Defense personnel.
  

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:
	90 FR 42399	09/02/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 58236	12/16/2025
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
DCS 343 and 344: Specific Authorization for Disclosure of Financial Information and Specific Authorization for Release of Behavioral Health and Related Medical Information	DCSA 343, DCSA 344	Specific Authorization for Disclosure of Financial Information ,   Specific Authorization for Release of Behavioral Health and Related Medical Information

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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	3,563	0	0	3,563	0	0
Annual Time Burden (Hours)	297	0	0	297	0	0
Annual Cost Burden (Dollars)	18,121	0	0	18,121	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 new associated burden.

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Annual Cost to Federal Government: $10,133

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: 12/16/2025

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