Applicant Background Questionnaire: Race, National Origin, Gender and Disability Demographics (Renewal)

Forms and Documents

Document Name	Status
Form 2248form03 Applicant Background Questionnaire: Race, National Origin, Gender and Disability Demographics Form	Modified
RNO-DEMOGRAPHIC form-EPA (WJA)-fin-rev07-28-08.doc Supplementary Document	2008-07-28
RNO-DEMOGRAPHIC form-EPA (WJA)-fin-rev05-15-08.doc Supplementary Document	2008-05-15
2248ss03[1].doc Supporting Statement A	2007-10-12

IC Document Collections

IC ID	Document Title	Status
179894	Applicant Background Questionnaire: Race, National Origin, Gender and Disability Demographics Form	Modified

ICR Details

OMB Control No: 2030-0045	ICR Reference No: 200710-2030-002
Status: Historical Active	Previous ICR Reference No: 200704-2030-001
Agency/Subagency: EPA/OMS	Agency Tracking No: 2248.03
Title: Applicant Background Questionnaire: Race, National Origin, Gender and Disability Demographics (Renewal)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/28/2008
	Date Received in OIRA: 10/23/2007
Terms of Clearance: This ICR extension is approved for 3 years. Sensitive questions regarding job applicant disabilities are not approved. OMB recommends that the Agency continue to work with relevant Federal Agencies to identify an appropriate survey on applicant disabilities such that the data will offer practical utility and also minimize the use of sensitive questions. Before resubmission of this ICR for extension, the Agency should revisit estimates of burden taking into account the EZhire platform for information collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2011	36 Months From Approved	07/31/2008
Responses	32,590	0	32,590
Time Burden (Hours)	15,209	0	15,209
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this information collection request is to seek approval to use the Environmental Protection Agency's EZhire, vacancy announcement and job application system to collect gender, race, national origin, and disability information from employees within the agency and outside job applicants. All job applicants, whether internal or external, would be asked to complete, on a voluntary basis, an Applicant Background Questionnaire: Race, National Origin, Gender, and Disability Demographics. This information is not currently being collected nor being reported to the Equal Employment Opportunity Commission (EEOC) and the Office of Personnel Management (OPM). Therefore, EPA is not in compliance with regulations which require the submission of race, national origin, gender, and disability data for various reporting purposes. The Equal Employment Opportunity Commission Management Directive 715, requires agencies to maintain a system that collects and maintains accurate information on the race, national origin, gender and disability of agency employees in accordance with 29 CFR 1614.601; maintain a system that tracks applicant flow data, which identifies applicants by race, national origin, gender, and disability status and disposition of all applications and maintain a tracking system of recruitment activities to permit analyses of these efforts in any examination of potential barriers to equality of opportunity. Management Directive 715 requires agencies to conduct an internal review and analysis of the effects of all current and proposed policies, practices, procedures and conditions that directly or indirectly, relate to the employment of individuals with disabilities based on their race, national origin, gender and disabilities. EPA must collect and evaluate the information and data necessary to make an informed assessment about the extent to which the Agency is meeting its responsibility to provide employment opportunities for qualified applicants and employees with disabilities, especially those with targeted disabilities.

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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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 37760	07/11/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 60015	10/23/2007
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
Applicant Background Questionnaire: Race, National Origin, Gender and Disability Demographics	2248form03	Applicant Background Questionnaire: Race, National Origin, Gender, and Disability Demographics

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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	32,590	32,590	0	0	0	0
Annual Time Burden (Hours)	15,209	15,209	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: $83,486

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: 10/23/2007

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