Applicant Questionnaire: Race, National Origin, Gender, and Disability Demographics

Forms and Documents

Document Name	Status
Form 3-378 Applicant Questionnaire, Race, National Origin, Gender and Disability Demographics Form	Modified
supporting_statment-EEO1_061109.doc Supporting Statement A	2009-06-11
29 CFR Section 1614_601 EEO group statistics.wpd Supplementary Document	2008-09-22

IC Document Collections

IC ID	Document Title	Status
184115	Applicant Questionnaire, Race, National Origin, Gender and Disability Demographics Form	Modified

ICR Details

OMB Control No: 1110-0047	ICR Reference No: 200806-1110-001
Status: Historical Active	Previous ICR Reference No: 200711-1110-002
Agency/Subagency: DOJ/FBI	Agency Tracking No:
Title: Applicant Questionnaire: Race, National Origin, Gender, and Disability Demographics
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/12/2009
	Date Received in OIRA: 09/22/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2012	36 Months From Approved
Responses	158,403,960	0	0
Time Burden (Hours)	30,462	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This form will be used to collect race, national origin, gender, and disability demographic information from applicant registering in the FBI's automated hiring system. The collection will meet the mandates of MD-175.

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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:
	73 FR 23272	12/17/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 39041	02/28/2008
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 Questionnaire, Race, National Origin, Gender and Disability Demographics	3-378	Applicant Questionnaire

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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	158,403,960	0	0	158,403,960	0	0
Annual Time Burden (Hours)	30,462	0	0	30,462	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: This is really a new collection, so we don't have a burden increase. We selected an existing collection without prior approval.

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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)? No

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: 09/22/2008

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