JWOD Employee Survey Questionnaire and JWOD Employee Information Form

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
28997	JWOD Employee Survey Questionnaire and JWOD Employee Information Form Form	Migrated

ICR Details

OMB Control No: 3037-0009	ICR Reference No: 199604-3037-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: CPBSD	Agency Tracking No:
Title: JWOD Employee Survey Questionnaire and JWOD Employee Information Form
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: 05/30/1996
	Date Received in OIRA: 04/05/1996
Terms of Clearance: This information collection is approved through 3-97 as modified by the 5-21-96 memo from the Committee for the Purchase from the Blind and Other Severly Handicapped. The Committee will add the statments required by the implementing regulations for the Paperwork Reduction Act at 5 CFR 1320.8(b)(3)(v) and (vi) to the JWOD Employee Information Form. For the JWOD Employee Survey Questionnaire, the Committee have the information required under 5 CFR 1320.(8)(b)(3) available for the interviewer to provide to the respondent. The Committee will immediately create a System of Records, as required by the Privacy Act to maintain individually identifiable information on participants in the program. In addition, the Committee will reduce the number of items requested in the JWOD Employee Information Form to reflect the requirement under the Privacy Act at 5 USC 552(e)(2) that to the extent possible Agencies will collect personal information from the individual directly. The Committee will refrain from asking the following questions on this form: 3,6,8,9,10. If the individual is unable to answer any of these questions, the Committee may then request this information from the employer.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/1997	03/31/1997
Responses	1	0	0
Time Burden (Hours)	624	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Survey of JWOD employess to measure the effects of the Javits- Wagner-O'Day Program on JWOD employees. This measure is to be one aspect of a comprehensive cost\benefit analysis of the JWOD program. The analysis is to be used to identify areas where improvements are desirable and collect in-depth descriptive data.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

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
JWOD Employee Survey Questionnaire and JWOD Employee Information Form	N/A

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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	1	0	0	1	0	0
Annual Time Burden (Hours)	624	0	0	624	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:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

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: 04/05/1996

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