EXPRESSED CONVICTIONS QUESTIONNAIRE

ICR 198703-0704-011

OMB: 0704-0196

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
165260 Migrated
ICR Details
0704-0196 198703-0704-011
Historical Active 198612-0704-001
DOD/DODDEP
EXPRESSED CONVICTIONS QUESTIONNAIRE
No material or nonsubstantive change to a currently approved collection   No
Emergency 03/09/1987
Approved with change 03/09/1987
Retrieve Notice of Action (NOA) 03/09/1987
  Inventory as of this Action Requested Previously Approved
01/31/1990 01/31/1990 01/31/1990
120 0 120
30 0 30
0 0 0

QUESTIONNAIRE (DISCO FORM 3) IS SENT TO CONTRACTOR EMPLOYEE WHO ARE PRESENTLY CLEARED OR WHO ARE IN PROCESS FOR A PERSONNEL SECURITY CLEARANCE AND WHO STATE THEY ARE UNWILLING OR DO NOT DESIRE T WORK ON CLASSIFIED DEFENSE WORK.

None
None


No

1
IC Title Form No. Form Name
EXPRESSED CONVICTIONS QUESTIONNAIRE FORM 3

  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 120 120 0 0 0 0
Annual Time Burden (Hours) 30 30 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/09/1987


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