Federal Register / Vol. 76, No. 85 / Tuesday, May 3, 2011 / Notices 24905 

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 by 

USCG 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 


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

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. 


srobinson on DSKHWCL6B1PROD with NOTICES
24908 Federal Register / Vol. 76, No. 85 / Tuesday, May 3, 2011 / Notices 

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 


srobinson on DSKHWCL6B1PROD with NOTICES