SCSEP Performance Measurement System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ETA-9120 SCSEP Participant Data Form	Form	Modified	Repair queued
Form ETA-9123 SCSEP Exit Form	Form	Modified	Available
Form ETA-9123 SCSEP Exit Form	Form	Modified	Available
Form ETA-9122 SCSEP Unsubsidized Employment Form	Form	Modified	Available
Form ETA-9122 SCSEP Unsubsidized Employment Form	Form	Modified	Available
Form ETA-9121 SCSEP Community Service Assignment Form	Form	Modified	Available
Form ETA-9121 SCSEP Community Service Assignment Form	Form	Modified	Available
Form ETA-9120 SCSEP Participant Data Form	Form	Modified	Available
Form ETA-8705 SCSEP Equitable Distribution Report	Form	Modified	Available
Form ETA-9124A SCSEP Participant Customer Satisfaction Survey	Form and Instruction	Unchanged	Repair queued
Form ETA-9124B SCSEP Host Agency Customer Satisfaction Survey	Form and Instruction	Unchanged	Repair queued
Form ETA-9124C SCSEP Employer Customer Satisfaction Survey	Form and Instruction	Unchanged	Repair queued
1205-0040 Supporting Statement 0607.doc	Supporting Statement A	Uploaded 2008-06-20	Available
1205-0040_Change_justificaiton(08-20-08).doc	Justification for No Material/Nonsubstantive Change	Uploaded 2008-06-20	Available
1205-0040 Supporting Statement revised June 19, 2008.doc	Supplementary Document	Uploaded 2008-06-19	Available
6-27 Comment Summary.doc	Supplementary Document	Uploaded 2007-06-27	Available
SupportPartB.doc	Supporting Statement B	Uploaded 2007-06-27	Available
SCSEP Privacy Statement.doc	Supplementary Document	Uploaded 2007-06-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43785	SCSEP Participant Data Form (State)	Form	Modified	SCSEP Participant Data Form
185407	SCSEP Four-Year State Strategy	Instruction	New
181013	SCSEP Exit Form (National)	Form	Modified	SCSEP Exit Form
181011	SCSEP Exit Form (State)	Form	Modified	SCSEP Exit Form
181010	SCSEP Unsubsidized Employment Form (National)	Form	Modified	SCSEP Unsubsidized Employment Form
181009	SCSEP Unsubsidized Employment Form (State)	Form	Modified	SCSEP Unsubsidized Employment Form
181008	SCSEP Community Service Assignment Form (National)	Form	Modified	SCSEP Community Service Assignment Form
181007	SCSEP Community Service Assignment Form (State)	Form	Modified	SCSEP Community Service Assignment Form
180574	SCSEP Participant Data Form (National)	Form	Modified	SCSEP Participant Data Form
180499	SCSEP Equitable Distribution Report	Form	Modified	SCSEP Equitable Distribution Report
180161	SCSEP Participant Customer Satisfaction Survey	Form and Instruction	Unchanged	SCSEP Participant Customer Satisfaction Survey
180160	SCSEP Employer and Host Agency Customer Satisfaction Surveys	Form and Instruction	Unchanged	SCSEP Host Agency Customer Satisfaction Survey
180160	SCSEP Employer and Host Agency Customer Satisfaction Surveys	Form and Instruction	Unchanged	SCSEP Employer Customer Satisfaction Survey

ICR Details

OMB Control No: 1205-0040	ICR Reference No: 200806-1205-007
Status: Historical Active	Previous ICR Reference No: 200704-1205-001
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: SCSEP Performance Measurement System
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: 06/27/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/20/2008
Terms of Clearance: This change makes a technical fix. This burden was previously discussed in the supporting statement, but not included in the ROCIS burden tally.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2010	10/31/2010	10/31/2010
Responses	324,474	0	324,446
Time Burden (Hours)	46,146	0	45,740
Cost Burden (Dollars)	0	0	0

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Abstract: For this non-substantive change, the 2007 Supporting Statement, #12A, and the total burden calculations in ROCIS have been revised to account for an inadvertent omission of the grantee portion of the burden for the four-year state strategy referred to in Item 2 of the Supporting Statement to account for the fact that all state and territorial grantees are required to submit a four-year senior community service and employment strategy. This plan needs to be up-dated at least every two years. Each grantee is devoting an average of 14.5 hours per year over the four years covered by the strategic plan. With 56 state and territorial grantees formulating or updating the plan an average of twice every four years, ETA estimates a total of 28 responses annually, for an hour burden of 406 hours per year (28 submissions x 14.5 hours).

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Authorizing Statute(s): PL: Pub.L. 109 - 365 501-518 Name of Law: Older Americans Act Amendments of 2006
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 365 513 Name of Law: Older Americans Act Amendments of 2006

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1205-AB47	Final or interim final rulemaking	72 FR 125	06/29/2007

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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: 12

table that charts list of burden

IC Title	Form No.	Form Name
SCSEP Community Service Assignment Form (National)	ETA-9121	SCSEP Community Service Assignment Form
SCSEP Community Service Assignment Form (State)	ETA-9121	SCSEP Community Service Assignment Form
SCSEP Employer and Host Agency Customer Satisfaction Surveys	ETA-9124C, ETA-9124B	SCSEP Employer Customer Satisfaction Survey ,   SCSEP Host Agency Customer Satisfaction Survey
SCSEP Equitable Distribution Report	ETA-8705	SCSEP Equitable Distribution Report
SCSEP Exit Form (National)	ETA-9123	SCSEP Exit Form
SCSEP Exit Form (State)	ETA-9123	SCSEP Exit Form
SCSEP Four-Year State Strategy
SCSEP Participant Customer Satisfaction Survey	ETA-9124A	SCSEP Participant Customer Satisfaction Survey
SCSEP Participant Data Form (National)	ETA-9120	SCSEP Participant Data Form
SCSEP Participant Data Form (State)	ETA-9120	SCSEP Participant Data Form
SCSEP Unsubsidized Employment Form (National)	ETA-9122	SCSEP Unsubsidized Employment Form
SCSEP Unsubsidized Employment Form (State)	ETA-9122	SCSEP Unsubsidized Employment Form

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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	324,474	324,446	0	28	0	0
Annual Time Burden (Hours)	46,146	45,740	0	406	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 burden for the four year state strategy on senior community service and employment, which inadvertently omitted the annualized state portion of that burden, has been adjusted to include burden hours for the four year strategic plan..

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Annual Cost to Federal Government: $43,313

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 06/20/2008

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