Applicant Background Questionnaire

Forms and Documents

Document Name	Status
Form HR-1225-0072 Applicant Background Questionaire - NRC Form	New
Form HR-1225-0072 Applicant Background Questionnaire - DOL Form	Modified
1225-0072_Change-Justification_NRC(8-8-07).doc Justification for No Material/Nonsubstantive Change	2007-08-08
1225-0072_30-day_FRN.pdf Supplementary Document	2007-08-08
1225-0072_60-day_FRN.pdf Supplementary Document	2007-08-08
1225-0072_SS_June05.doc Supporting Statement A	2007-08-08

IC Document Collections

IC ID	Document Title	Status
181482	Applicant Background Questionaire - NRC Form	New
14719	Applicant Background Questionnaire - DOL Form	Modified

ICR Details

OMB Control No: 1225-0072	ICR Reference No: 200708-1225-002
Status: Historical Active	Previous ICR Reference No: 200506-1225-001
Agency/Subagency: DOL/DM	Agency Tracking No: NRC-2007
Title: Applicant Background Questionnaire
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/28/2007
	Date Received in OIRA: 08/08/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2008	10/31/2008	10/31/2008
Responses	5,000	0	3,000
Time Burden (Hours)	250	0	150
Cost Burden (Dollars)	0	0	0

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Abstract: This survey, to be completed voluntarily by job applicants, provides information on the applicants' gender, race or ethnicity, disability, and the applicants' source of recruitment information for vacancy. This data will be used to evaluate the effectiveness of various recruitment methods to tailor recruitment to meet equal employment opportunity objectives.

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Authorizing Statute(s): US Code: 5 USC 7201(c) Name of Law: Antidiscrimination policy; minority recruitment program
   US Code: 29 USC 791 Name of Law: Employment of individuals with disabilities
  

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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Applicant Background Questionaire - NRC	HR-1225-0072	Applicant Background Questionaire
Applicant Background Questionnaire - DOL	HR-1225-0072	Applicant Background Questionaire

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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	5,000	3,000	0	2,000	0	0
Annual Time Burden (Hours)	250	150	0	100	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The U.S. Nuclear Regulatory Agency (NRC)has requested permission to use unchanged the Department of Labor’s OMB-approved Applicant Background Questionnaire for the same purposes as stated in the attached Supporting Statements (see supplementary documents). The burden inventory for this OMB control number is updated to include new level of burden associated with NRC’s use of the form.

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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: 08/08/2007

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