(a) Complaint of Possible Prohibited Personnel Practice or Other Prohibited Activity, (b) Disclosure of Information

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OSC Form 13 (a) Complaint of Possible Prohibited Personnel Practice or Other Prohibited Activity, (b) Disclosure of Information	Form and Instruction	Modified	Available
Supporting Statement for OMB Form 83-I[1].doc	Supporting Statement A	Uploaded 2006-11-08	Available
osc14.pdf	Supplementary Document	Uploaded 2006-11-08	Available
osc13.pdf	Supplementary Document	Uploaded 2006-11-08	Available
osc12.date fixed.pdf	Supplementary Document	Uploaded 2006-11-08	Available
osc11.pdf	Supplementary Document	Uploaded 2006-11-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
35835	(a) Complaint of Possible Prohibited Personnel Practice or Other Prohibited Activity, (b) Disclosure of Information	Form and Instruction	Modified

ICR Details

OMB Control No: 3255-0002	ICR Reference No: 200611-3255-001
Status: Historical Active	Previous ICR Reference No: 200306-3255-001
Agency/Subagency: OSC	Agency Tracking No:
Title: (a) Complaint of Possible Prohibited Personnel Practice or Other Prohibited Activity, (b) Disclosure of Information
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: 12/28/2006
	Date Received in OIRA: 11/08/2006
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2009	36 Months From Approved	12/31/2006
Responses	2,246	0	2,246
Time Burden (Hours)	2,689	0	2,689
Cost Burden (Dollars)	0	0	0

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Abstract: Forms are needed to obtain information about allegations of prohibited employment practices, and about whistleblower disclosures of information, from current/former Federal employees and applicants for employment. Information is used to investigate and seek appropriate remedies for prohibited employment practices, and to review, and refer, as appropriate, disclosures of wrongdoing for investigation by the head of the agency involved.

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Authorizing Statute(s): US Code: 5 USC CFR1800 Name of Law: Code of Federal Regulations
  

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:
	71 FR 199	02/15/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 199	10/16/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
(a) Complaint of Possible Prohibited Personnel Practice or Other Prohibited Activity, (b) Disclosure of Information	OSC Form 13, OSC Form 14, OSC-11, OSC-12	Complaint of Possible Prohibited Political Activity (Violation of the Hatch Act) ,   Complaint of Possible Prohibited Personnel Practice ,   Complaint of Possible Violation of USERRA ,   Information About Filing a Whistleblower Disclosure with the Office of Special Counsel

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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	2,246	2,246	0	0	0	0
Annual Time Burden (Hours)	2,689	2,689	0	0	0	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:

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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? Yes

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: 11/08/2006

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