Human Reliability Program

Forms and Documents

Document Name	Status
Form DOE F 470.7 Human Reliability Program (HRP) Alcohol Testing Form Form and Instruction	New
Form DOE F 470.6 Refusal to Consent Form	New
Form DOE F 470.5 Authorization and Consent to Release Human Reliability (HRP) Records in Connection with HRP Form	New
Form DOE F 470.4 Acknowledgement and Agreement to Participate in the Human Reliability Program (HRP) Form	New
Form DOE F 470.3 Human Reliability Program Form	Modified
Human--descrip of collection forms 10 24 06.rtf Supplementary Document	2006-10-24
No Supporting Statement.doc Supporting Statement A	2006-11-09

IC Document Collections

IC ID	Document Title	Status
44899	Human Reliability Program (HRP) Alcohol Testing Form Form and Instruction	New
44898	Refusal to Consent Form	New
44895	Authorization and Consent to Release Human Reliability (HRP) Records in Connection with HRP Form	New
44890	Acknowledgement and Agreement to Participate in the Human Reliability Program (HRP) Form	New
23449	Human Reliability Program Form	Modified

ICR Details

OMB Control No: 1910-5122	ICR Reference No: 200608-1910-013
Status: Historical Inactive	Previous ICR Reference No: 200304-1910-001
Agency/Subagency: DOE/DOEOA	Agency Tracking No:
Title: Human Reliability Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 11/09/2006
	Date Received in OIRA: 08/23/2006
Terms of Clearance: Agency submitted incorrect Supporting Statement A.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2006	36 Months From Approved	02/28/2007
Responses	12,500	0	12,500
Time Burden (Hours)	54,000	0	54,000
Cost Burden (Dollars)	0	0	0

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Abstract: Forms will certify to DOE that respondents were advised of the requirements for occupying or continuing to occupy a Human Reliability Program position.

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Authorizing Statute(s): US Code: 42 USC 7254 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1992-AA29	Final or interim final rulemaking	69 FR 15	01/23/2006

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 59	03/28/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 141	07/24/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Authorization and Consent to Release Human Reliability (HRP) Records in Connection with HRP	DOE F 470.5	Authorization and Consent to Release Human Reliability Program (HRP) Records in Connection with HRP
Refusal to Consent	DOE F 470.6	Refusal of Consent
Human Reliability Program (HRP) Alcohol Testing Form	DOE F 470.7	Human Reliability Program (HRP) Alcohol Testing Form
Acknowledgement and Agreement to Participate in the Human Reliability Program (HRP)	DOE F 470.4	Acknowledgment and Agreement to Participate in the Human Reliability Program (HRP)
Human Reliability Program	DOE F 470.3	Human Reliability Program (HRP) Certification

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: The total number of respondents reported in the previous submission was an estimate, since the program was new. The program has now been in existence for three years and a more precise determination as to the number of respondents can be made. The total number of respondents is 11,500 (Human Reliability Program positions). Each respondent must complete each of the 5 forms so the total number of responses equals 11,500 respondents times 5 responses which equals 57,500 annual responses. The total number of annual hours required for the collection has been significantly reduced based upon actual experience in the administration of the program over the previous three years (previously 54,000—currently 5,750).

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Annual Cost to Federal Government: $0

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]? 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: 08/23/2006

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