Human Reliability Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DOE F 470.7 Human Reliability Program (HRP) Alcohol Testing Form	Form and Instruction	Modified	Available
Form DOE F 470.6 Refusal of Consent	Form	Modified	Available
Form DOE F 470.5 Authorization and Consent to Release Human Reliability Program (HRP) Records in Connection with HRP	Form	Modified	Available
Form DOE F 470.4 Acknowledgment and Agreement to Participate in the Human Reliability Program (HRP)	Form	Modified	Available
Form DOE F 470.3 Human Reliability Program (HRP) Certification	Form	Modified	Available
Human--descrip of collection forms 02 22 07rev1.pdf	Supplementary Document	Uploaded 2007-02-22	Available
Human--Renewal Forms--Supporting Statement 02 22 07.pdf	Supporting Statement A	Uploaded 2007-02-22	Available

IC Document Collections

Information collection document groups

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

ICR Details

OMB Control No: 1910-5122	ICR Reference No: 200611-1910-003
Status: Historical Active	Previous ICR Reference No: 200608-1910-013
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: Approved without change	Conclusion Date: 02/23/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/28/2006
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2010	36 Months From Approved	02/28/2007
Responses	57,500	0	12,500
Time Burden (Hours)	5,750	0	54,000
Cost Burden (Dollars)	0	0	0

---

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

---

Authorizing Statute(s): US Code: 42 USC 7254
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 59	04/28/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 141	07/24/2006
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
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)
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
Human Reliability Program	DOE F 470.3	Human Reliability Program (HRP) Certification
Human Reliability Program (HRP) Alcohol Testing Form	DOE F 470.7	Human Reliability Program (HRP) Alcohol Testing Form
Refusal to Consent	DOE F 470.6	Refusal of Consent

---

ICR Summary of Burden

table that charts list 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	57,500	12,500	0	0	45,000	0
Annual Time Burden (Hours)	5,750	54,000	0	0	-48,250	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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 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).

---

Annual Cost to Federal Government: $385,250

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

---

Common Form ICR:  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:

(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: 11/28/2006

---