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protection of the confidential information by making reconstruction or compromise by reuse impracticable.

Records located away from the destruction site shall be transferred to the destruction site in the confidential manner. No other information about Employee Assistance Program clients may be maintained once these files have been destroyed.

**SYSTEM MANAGER AND ADDRESS :** 

Commandant, CG–1112, Office of Work-Life, United States Coast Guard Headquarters, 2100 2nd Street, SW., Washington, DC 20593–0001.

**NOTIFICATION PROCEDURE :** 

Individuals seeking notification of and access to any record contained in this system of records, or seeking to contest its content, may submit a request in writing to Commandant, CG– 1112, Office of Work-Life, United States Coast Guard Headquarters, 2100 2nd Street, SW., Washington, DC 20593–
0001.

When seeking records about yourself from this system of records or any other USCG system of records your request must conform with the Privacy Act regulations set forth in 6 CFR part 5. You must first verify your identity, meaning that you must provide your full name, current address and date and place of birth. You must sign your request, and your signature must either be notarized or submitted under 28 U.S.C. 1746, a law that permits statements to be made under penalty of perjury as a substitute for notarization. While no specific form is required, you may obtain forms for this purpose from the Director, Disclosure and FOIA, http://www.dhs.gov or 1–866–431–0486. In addition you should provide the following:

• An explanation of why you believe the Department would have information
on you;

• Specify when you believe the records would have been created;

• If your request is seeking records pertaining to another living individual, you must include a statement from that individual certifying his/her agreement for you to access his/her records.

Without this bulleted information the USCG will not be able to conduct an effective search, and your request may be denied due to lack of specificity or lack of compliance with applicable regulations.

**RECORD ACCESS PROCEDURES :** 

See ‘‘Notification Procedure ’’ above.

**CONTESTING RECORD PROCEDURES :** 

See ‘‘Notification Procedure ’’ above. **RECORD SOURCE CATEGORIES :** 
Records are retained from the following sources:

• USCG Employee Assistance Program: the client, the licensed mental health provider, and collateral sources and resources intended to help the client.

• USCG Workplace Violence and related Critical Incident Team: investigation records, personnel records, critical incident team assembled to make recommendations to command, subject’s supervisors, and the subject.

• USCG Critical Incident Stress Management-related records: Work-Life staff, Peers, Incident commander, command(s) affected, individuals impacted by incident, other support persons who may be mobilized to assist those impacted by the event.

• USCG Sexual Assault Prevention and Response Program: victim, victim support person, medical personnel assisting victim, criminal investigations and investigators, and other support personnel intended to assist victim.

• USCG Victim Support Persons(VSP): the victim support person, WorkLife staff, VSP’s or Victim Advocate’s work supervisor, other support persons who may assist in training.

• USCG Critical Incident Stress Management Peer Volunteers: Peer, Peer’s supervisor, Work-Life staff, and other support persons who may assist in training.

• Case records maintained by USCG Work-Life personnel on USCG Duty members who have demonstrated suicidal behavior: the patient, medical personnel, patient’s command, and Work-Life staff and other support persons who may assist in helping the patient.

• Reports of USCG active duty suicidal behavior incidents, work place violence incidents, critical incidents, and sexual assaults maintained byUSCG Headquarters (CG–1112): WorkLife staff and others as described above under their related programs.

**EXEMPTIONS CLAIMED FOR THE SYSTEM :** 

None.
Dated: April 23, 2011. Mary Ellen Callahan, Chief Privacy Officer, Department of Homeland Security.
[FR Doc. 2011–10719 Filed 5–2–11; 8:45 am]

**BILLING CODE 9110–04–P DEPARTMENT OF HOMELAND**  **SECURITY**

**Office of the Secretary**

**[Docket No. DHS–2011–0020]**

**Privacy Act of 1974; Department of Homeland Security United States**  **Coast Guard—DHS/USCG–007 Special Needs Program System of Records** 

**AGENCY :**  Privacy Office, DHS.

**ACTION :**  Notice of Privacy Act system of records.

**SUMMARY :**  In accordance with the Privacy Act of 1974, the Department of Homeland Security proposes to update and rename an existing Department of Homeland Security system of records titled, ‘‘Department of Homeland Security/United States Coast Guard–007 Exceptional Family Member Program System of Records. ’’ This system will allow the Department of Homeland Security United States Coast Guard meet it obligation to assist military personnel, civilian personnel and their eligible dependents with special needs. As a result of the required biennial review of this system, records have been updated to reflect the name change to Department of Homeland Security/ United States Coast Guard Special Needs Program Record. This updated system will be included in the Department of Homeland Security’s inventory of record systems.

**DATES :**  Submit comments on or before June 2, 2011. This updated system will be effective June 2, 2011.

**ADDRESSES :**  You may submit comments, identified by docket number DHS– 2011–0020 by one of the following methods:

• Federal e-Rulemaking Portal: http://www.regulations.gov. Follow the instructions for submitting comments.

• Fax: 703–483–2999.

• Mail: Mary Ellen Callahan, Chief Privacy Officer, Privacy Office, Department of Homeland Security, Washington, DC 20528.

• Instructions: All submissions received must include the agency name and docket number for this rulemaking. All comments received will be posted without change to http:// www.regulations.gov, including any personal information provided.

• Docket: For access to the docket, to read background documents, or comments received go to http:// www.regulations.gov

. **FOR FURTHER INFORMATION CONTACT :**  For general questions please contact: Eileen Yenikaliotis (202–475–3515), Acting Privacy Officer, United States Coast


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Guard 2100 2nd Street SW., Washington, DC 20593. For privacy issues please contact: Mary Ellen Callahan (703–235–0780), Chief Privacy Officer, Privacy Office, U.S. Department of Homeland Security, Washington, DC
20528.

**SUPPLEMENTARY INFORMATION :**  I. Background

In accordance with the Privacy Act of 1974, the Department of Homeland Security (DHS) United States Coast Guard (USCG) proposes to update and rename an existing DHS system of records titled, ‘‘DHS/USCG–007 Exceptional Family Member Program.

This system will allow the Department of Homeland Security/ United States Coast Guard to collect and maintain records on civilians, active duty, reserve, retired active duty and retired reserve military personnel, and their eligible dependents with special needs.

As a result of the biennial review of this system, the term ‘‘Exceptional Family Member Program ’’ has been replaced by term ‘‘ Special Needs ’’ in the preamble, Supplementary Information, System Name, and Purpose categories of the SORN.

Consistent with DHS’ information sharing mission, information stored in DHS/USCG–007 Special Needs Program Records may be shared with other DHS components, as well as appropriate federal, state, local, tribal, territorial foreign, or international government agencies. This sharing will only occur after DHS determines that the receiving component or agency has a need to know the information to carry out national security, law enforcement, immigration, intelligence, or other functions consistent with the routine uses set forth in this system of records notice. This updated system will be included in DHS’ inventory of record systems. II. Health Insurance Portability and Accountability Act

This system of records contains individually identifiable health information. The Department of Defense Health Information Privacy Regulation (DoD 6025.18–R) issued pursuant to the Health Insurance Portability and Accountability Act of 1996, applies to most such health information. Department of Defense 6025.18–R may place additional procedural requirements on the uses and disclosures of such information beyond those found in the Privacy Act of 1974 or mentioned in this system of records notice. III. Privacy Act The Privacy Act embodies fair information practice principles in a statutory framework governing the means by which the U.S. Government collects, maintains, uses and disseminates individuals’ records. The Privacy Act applies to information that is maintained in a ‘‘ system of records. ’’ A ‘‘ system of records ’’ is a group of any records under the control of an agency for which information is retrieved by the name of an individual or by some identifying number, symbol, or other identifying particular assigned to the individual. In the Privacy Act, an individual is defined to encompass U.S. citizens and lawful permanent residents. As a matter of policy DHS extends administrative Privacy Act protections to all individuals where system of records maintain information on U.S. citizens, lawful permanent residents, and visitors. Below is the description of the DHS/USCG—007 Special Needs Program System of Records.

In accordance with 5 U.S.C. 552a(r), DHS has provided a report of this new system of records to the Office of Management and Budget and to Congress.

**SYSTEM OF RECORDS**

DHS/USCG–007.

**SYSTEM NAME :** 

DHS/USCG–007 Special Needs Program.

**SECURITY CLASSIFICATION :** 

Unclassified.

**SYSTEM LOCATION :** 

Records are maintained at USCG Headquarters in Washington, DC and field locations.

**CATEGORIES OF INDIVIDUALS COVERED BY THE**
**SYSTEM :** 

Coast Guard active duty, reserve, retired active duty, retired reserve, and civilian personnel and their eligible dependents who have a long-term physical or mental chronic condition that substantially limits one or more of the major life activities of an individual including professionally diagnosed medical, physical, psychological, and/or educational disabilities.

**CATEGORIES OF RECORDS IN THE SYSTEM :** 

Categories of records in this system include:

• Military or civilian personnel’s

name;

• Eligible dependent’s name and birth date; • Service member’s, civilian’s or eligible dependents home address, phone numbers, and email information;

• Identification number (EMPLID); social security numbers of the service member or civilian personnel are currently in the case records (we will no longer be asking for those in the new policy, but the numbers will still be in all of the old files);

• Eligible dependent’s diagnosed special need, including copies of medical, educational, and psychological reports, enrollment forms, correspondence and follow-up, and any other data relevant to the dependent’s individual special needs’ program files; and

• Benefits, including case management activities, and supports and services received related to the special need.

**AUTHORITY FOR MAINTENANCE OF THE SYSTEM :** 

The Homeland Security Act of 2002, Public Law 107–296, Federal Records Act, 44 U.S.C. 3101; 6 CFR part 5; 5 U.S.C. 301, and COMNDTINST 1754.7 (series).

**PURPOSE (**  **S ):** 

The purpose of this system is to administer special needs requests of USCG military and civilian personnel to coordinate the special needs program’s medical care, mental health treatment, and to provide case management for USCG military and civilian personnel and eligible dependants with special needs.

**ROUTINE USES OF RECORDS MAINTAINED IN THE**
**SYSTEM ,**  **INCLUDING CATEGORIES OF USERS AND**
**THE PURPOSES OF SUCH USES :** 

This system of records contains individually identifiable health information. The Department of Defense Health Information Privacy Regulation (DoD 6025.18–R) issued pursuant to the Health Insurance Portability and Accountability Act of 1996, applies to most such health information. Department of Defense 6025.18–R may place additional procedural requirements on the uses and disclosures of such information beyond those found in the Privacy Act of 1974 or mentioned in this system of records notice.

In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, all or a portion of the records or information contained in this system may be disclosed outside DHS as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows:

A. To the Department of Justice (including United States Attorney


### 24907 Federal Register / Vol. 76, No. 85 / Tuesday, May 3, 2011 / Notices

Offices) or other Federal agency conducting litigation or in proceedings before any court, adjudicative or administrative body when it is necessary to the litigation and one of the following is a party to the litigation or has an interest in such litigation:

1. DHS or any component thereof; 2. Any employee of DHS in his/her official capacity;

3. Any employee of DHS in his/her individual capacity where DOJ or DHS has agreed to represent the employee; or

4. The United States or any agency thereof, is a party to the litigation or has an interest in such litigation, and DHS determines that the records are both relevant and necessary to the litigation and the use of such records is compatible with the purpose for which DHS collected the records.

B. To a congressional office from the record of an individual in response to an inquiry from that congressional office made at the request of the individual to whom the record pertains.

C. To the National Archives and Records Administration or other federal government agencies pursuant to records management inspections being conducted under the authority of 44 U.S.C. 2904 and 2906.

D. To an agency, organization, or individual for the purpose of performing audit or oversight operations as authorized by law, but only such information as is necessary and relevant to such audit or oversight function.

E. To appropriate agencies, entities, and persons when:

1. DHS suspects or has confirmed that the security or confidentiality of information in the system of records has been compromised;

2. The Department has determined that as a result of the suspected or confirmed compromise there is a risk of harm to economic or property interests, identity theft or fraud, or harm to the security or integrity of this system or other systems or programs (whether maintained by DHS or another agency or entity) or harm to the individual who relies upon the compromised information; and

3. The disclosure made to such agencies, entities, and persons is reasonably necessary to assist in connection with DHS’s efforts to respond to the suspected or confirmed compromise and prevent, minimize, or remedy such harm.

F. To contractors and their agents, grantees, experts, consultants, and others performing or working on a contract, service, grant, cooperative agreement, or other assignment for DHS, when necessary to accomplish an agency function related to this system of records. Individuals provided information under this routine use are subject to the same Privacy Act requirements and limitations on disclosure as are applicable to DHS officers and employees.

G. To an appropriate Federal, State, tribal, local, international, or foreign law enforcement agency or other appropriate authority charged with investigating or prosecuting a violation or enforcing or implementing a law, rule, regulation, or order, where a record, either on its face or in conjunction with other information, indicates a violation or potential violation of law, which includes criminal, civil, or regulatory violations and such disclosure is proper and consistent with the official duties of the person making the disclosure.

H. To any member of the family when a signed release of information is documented in the case record, in furtherance of treating the family member with special needs.

I. To officials and employees of local and state governments and agencies in the performance of their official duties pursuant to the laws and regulations governing local control of communicable diseases, preventive medicine and safety programs, developmental disabilities, and other public health and welfare programs.

K. To the federal, state or local governmental agencies when appropriate in the counseling and treatment of individuals or families with special medical or educational needs, or receiving early intervention or related services.

**DISCLOSURE TO CONSUMER REPORTING**
**AGENCIES :** 

None.

**POLICIES AND PRACTICES FOR STORING ,**  **RETRIEVING ,**  **ACCESSING ,**  **RETAINING ,**  **AND**
**DISPOSING OF RECORDS IN THE SYSTEM :** 

**STORAGE :** 

Records in this system are stored electronically or on paper in a locked drawer behind a locked door. The records are stored on magnetic disc, tape, digital media, and CD–ROM.

**RETRIEVABILITY :** 

Data may be retrieved by a Coast Guard military or civilian personnel’s name and/or identification number (EMPLID).

**SAFEGUARDS :** 

Records in this system are safeguarded in accordance with applicable rules and policies, including all applicable DHS automated systems security and access policies. Strict controls have been imposed to minimize the risk of compromising the information that is being stored. Access to the computer system containing the records in this system is limited to those individuals who have a need to know the information for the performance of their official duties and who have appropriate clearances or permissions.

**RETENTION AND DISPOSAL :** 

Case records are maintained at a decentralized location until the USCG military or civilian personnel is separated or retired, eligible family member is no longer an eligible dependent, or the eligible dependent is no longer diagnosed as having a special need. Upon separation or retirement of the USCG military or civilian personnel, the eligible family member is no longer an eligible dependent, or when the eligible dependent is no longer diagnosed as having a special need, the record will be transferred to Commandant, CG–1112. After a 3-year retention, the record is destroyed (N1– 026–07–9).

**SYSTEM MANAGER AND ADDRESS :** 

Chief, Office of Work-Life, Director of Health, Safety and Work-Life, CG–11, United States Coast Guard, Washington, DC 20593–0001.

**NOTIFICATION PROCEDURE :** 

Individuals seeking notification of and access to any open record contained in this system of records, or seeking to contest its content, may submit a request in writing to the Work-Life field office where the case record is maintained. Individuals seeking notification of and access to any closed record contained in this system of records, or seeking to contest its content, may submit a request in writing to the Chief, Office of Work-Life,Director of Health, Safety and WorkLife, CG–11, United States Coast Guard, Washington, DC 20593–0001.

When seeking records about yourself or your minor dependent from this system of records or any other USCG system of records your request must conform with the Privacy Act regulations set forth in 6 CFR part 5. You must first verify your identity, meaning that you must provide your full name, current address and date and place of birth. You must sign your request, and your signature must either be notarized or submitted by you under 28 U.S.C. 1746, a law that permits statements to be made under penalty of perjury as a substitute for notarization. While no specific form is required, you may obtain forms for this purpose from the Director, Disclosure and FOIA, http://www.dhs.gov or 1–866–431–0486.


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In addition you should provide the following:

• An explanation of why you believe the Department would have information
on you,

• Specify when you believe the records would have been created,

• If your request is seeking records pertaining to another living individual, you must include a statement from that individual certifying his/her agreement for you to access his/her records.

Without this bulleted information the USCG may not be able to conduct an effective search, and your request may be denied due to lack of specificity or lack of compliance with applicable regulations.

**RECORD ACCESS PROCEDURES :** 

See ‘‘Notification procedure ’’ above.

**CONTESTING RECORD PROCEDURES :** 

See ‘‘Notification procedure ’’ above.

**RECORD SOURCE CATEGORIES :** 

Records are obtained from medical reports that are provided to the USCG.

**EXEMPTIONS CLAIMED FOR THE SYSTEM :** 

None. Dated: April 23, 2011. Mary Ellen Callahan, Chief Privacy Officer, Department of Homeland Security.
[FR Doc. 2011–10756 Filed 5–2–11; 8:45 am]

**BILLING CODE 4410–10–P**

**DEPARTMENT OF HOMELAND SECURITY** 

**U.S. Citizenship and Immigration Services** 

**Agency Information Collection Activities: Form I–693, Revision of a**  **Currently Approved Information Collection; Comment Request** 

**ACTION :**  60-Day Notice of Information Collection Under Review: Form I–693, Report of Medical Examination and Vaccination Record, OMB Control No.
1615–0033.

The Department of Homeland Security, U.S. Citizenship and Immigration Services (USCIS) will be submitting the following information collection request for review and clearance in accordance with the Paperwork Reduction Act of 1995. The information collection is published to obtain comments from the public and affected agencies. Comments are encouraged and will be accepted for 60 days until July 5, 2011.

Written comments and suggestions regarding items contained in this notice, and especially with regard to the estimated public burden and associated response time should be directed to the Department of Homeland Security (DHS), USCIS, Chief, Regulatory Products Division, Office of the Executive Secretariat, Clearance Officer, 20 Massachusetts Avenue, NW., Washington, DC 20529–2020. Comments may also be submitted to DHS via facsimile to 202–272–0997 or via e-mail at rfs.regs@dhs.gov. When submitting comments by e-mail please add the OMB Control Number 1615– 0033 in the subject box.

Note: The address listed in this notice should only be used to submit comments concerning this information collection. Please do not submit requests for individual case status inquiries to this address. If you are seeking information about the status of your individual case, please check ‘‘ My Case Status ’’ online at: https://egov.uscis.gov/cris/ Dashboard.do, or call the USCIS National Customer Service Center at 1–800–375–5283.

Written comments and suggestions from the public and affected agencies concerning the proposed collection of information should address one or more of the following four points:

(1) Evaluate whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have practical utility;

(2) Evaluate the accuracy of the agencies estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used;

(3) Enhance the quality, utility, and clarity of the information to be collected; and

(4) Minimize the burden of the collection of information on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of
responses.
Overview of This Information Collection

(1) Type of Information Collection: Revision of a currently approved information collection.

(2) Title of the Form/Collection: Report of Medical Examination and Vaccination Record.

(3) Agency form number, if any, and the applicable component of the Department of Homeland Security sponsoring the collection: Form I–693. U.S. Citizenship and Immigration Services. (4) Affected public who will be asked or required to respond, as well as brief abstract: Primary: Individuals or households. The information on the application will be used by USCIS in considering the eligibility for adjustment of status under 8 CFR part 209 and 8 CFR 210.5, 245.1, and 245a.3.

(5) An estimate of the total annual number of respondents and the amount of time estimated for an average respondent to respond: 800,000 responses at 2.5 hours per response.

(6) An estimate of the total annual public burden (in hours) associated with the collection: 2,000,000 annual burden hours.

If you need a copy of the information collection instrument, please visit the USCIS Web site at: http:// www.regulations.gov/.

We may also be contacted at: USCIS, Regulatory Products Division, Office of the Executive Secretariat, 20 Massachusetts Avenue, NW., Room 5012, Washington, DC 20529–2020, Telephone number 202–272–8377.

Dated: April 27, 2011. Sunday A. Aigbe, Chief, Regulatory Products Division, Office of the Executive Secretariat, U.S. Citizenship and Immigration Services, Department of Homeland Security.
[FR Doc. 2011–10645 Filed 5–2–11; 8:45 am]

**BILLING CODE 9111–97–P**

**DEPARTMENT OF HOMELAND SECURITY** 

**U.S. Citizenship and Immigration Services** 

**Agency Information Collection Activities: Form G–639; Extension of**  **an Existing Information Collection; Comment Request** 

**ACTION :**  60-Day Notice of Information Collection Under Review; Form G–639, Freedom of Information/Privacy Act Request; OMB Control No. 1615–0102.

The Department of Homeland Security, U.S. Citizenship and Immigration Services (USCIS) will be submitting the following information collection request for review and clearance in accordance with the Paperwork Reduction Act of 1995. The information collection is published to obtain comments from the public and affected agencies. Comments are encouraged and will be accepted for sixty days until July 5, 2011.

During this 60 day period, USCIS will be evaluating whether to revise the Form G–639. Should USCIS decide to revise Form G–639 we will advise the