Gratuitous Services Agreement and Volunteer Release and Hold Harmless

Forms and Documents

Document Name	Status
privacy-dhs-all-pia-006-update-June2016.pdf Supplementary Document	2016-09-16
PTA, NPPD - Gratuitous Services Agreement Volunteer Participant Release ....pdf Supplementary Document	2016-09-16
hr_5005_enr.pdf Supplementary Document	2016-06-22
USCODE-2010-title6-chap1-subchapII-partA-sec121 Infrastructure Protection access to information.pdf Supplementary Document	2016-05-16
Homeland Security Presidential Directive 19 (HSPD-19).pdf Supplementary Document	2016-05-16
PPD 7 Homeland Security Presidential Directive 7 Critical Infrastructure Identification, Prioritization, and Protection.pdf Supplementary Document	2016-05-16
President’s Policy Directive-17 Countering Improvised Explosive Devices PPD-17.pdf Supplementary Document	2016-05-16
NSPD 17 - HSPD 4 (unclassified version) National Strategy to Combat Weapons of Mass Destruction..pdf Supplementary Document	2016-05-16
DHS-2015-0028-0002 published 30-day FRN v81 no25 pg6531-6532 2-8-2016.pdf Supplementary Document	2016-05-16
DHS-2015-0028-0001 1670-NEW OBP 60day published v80 no161 pg 50649 08-20-2015.pdf Supplementary Document	2016-05-16
Supporting Statement A_Gratuitous Services_Volunteer Release V3 09-16-2016.doc Supporting Statement A	2016-09-16

IC Document Collections

IC ID	Document Title	Status
221540	Gratuitous Services Agreement and Volunteer Release and Hold Harmless Other-Form Agreement	New

ICR Details

OMB Control No: 1670-0031	ICR Reference No: 201605-1670-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DHS/CISA	Agency Tracking No:
Title: Gratuitous Services Agreement and Volunteer Release and Hold Harmless
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: 03/06/2017
	Date Received in OIRA: 09/20/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved
Responses	750	0	0
Time Burden (Hours)	150	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the Volunteer Participant Release of Liability Agreement is to collect necessary information in case an individual who acts as a volunteer role player in support of official OBP training sustains an injury or death during the performance of his or her supporting role. If legal action is taken, this information can serve as a “hold harmless” statement /agreement by the Government. In the unlikely event that an injury or death is sustained in the performance of support for training, this information will be used by NPPD/IP/PSCD/OBP to protect against legal action by the volunteer or their family. If legal action is taken, this information can serve as a “hold harmless” statement /agreement by the Government.

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Authorizing Statute(s): PL: Pub.L. 107 - 296 6 U.S.C. § 121 Name of Law: Homeland Security Act - Section 201
  

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:
	80 FR 50649	08/20/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 6531	02/08/2016
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
Gratuitous Services Agreement and Volunteer Release and Hold Harmless

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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	750	0	0	750	0	0
Annual Time Burden (Hours)	150	0	0	150	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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.

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Annual Cost to Federal Government: $6,831

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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: 09/20/2016

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