Employment Verification Questionnaire

Forms and Documents

Document Name	Status
Form AID XXX Employment Verification Questionnaire Form	New
OMB - Supporting Statement - Employment Verification Questionnaire.doc Supporting Statement A	2008-09-15

IC Document Collections

IC ID	Document Title	Status
186580	Employment Verification Questionnaire Form	New

ICR Details

OMB Control No: 0412-0578	ICR Reference No: 200809-0412-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: AID	Agency Tracking No:
Title: Employment Verification Questionnaire
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 09/26/2008
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/20/2008
	Date Received in OIRA: 09/16/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2009	6 Months From Approved
Responses	75	0	0
Time Burden (Hours)	300	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This information collection is being created in response to the requirements in Section 1248(c) of the National Defense Authorization Act for Fiscal Year 2008 (Public Law 110-181). Congress has requested that a number of Departments and Agencies, including USAID, examine the options for establishing a unified, classified database of specific personal information data elements of Iraqi employees related to contracts, grants, or cooperative agreements entered into by these Departments and Agencies for the performance of work in Iraq since March 20, 2003 to assist Iraqi refugees with resettlement to the United States.

Emergency Justfication: Pursuant to 5 CFR 1320.13, it is determined that: This information collection is being created in response to the requirements in Section 1248(c) of the National Defense Authorization Act for Fiscal Year 2008 (Public Law 110-181). Congress has requested that a number of Departments and Agencies, including USAID, examine the options for establishing a unified, classified database of specific personal information data elements of Iraqi employees related to contracts, grants, or cooperative agreements entered into by these Departments and Agencies for the performance of work in Iraq since March 20, 2003 to assist Iraqi refugees with resettlement to the United States. The Agency met with nine implementing partners on September 12, 2008, to discuss the potential burden of answering this questionnaire and whether the partners would have access to employment verification information for Iraqi citizens and nationals. Further, the Agency is limiting the questionnaire to ask only for those fields of information that are necessary to confirm that an Iraqi citizen or national worked for the United States Government and to entitle them to a Special Immigrant Visa.

---

Authorizing Statute(s): PL: Pub.L. 110 - 181 1248(c) Name of Law: National Defense Authorization Act for Fiscal Year 2008
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Employment Verification Questionnaire	AID XXX	Employment Verification Questionnaire

---

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	75	0	0	75	0	0
Annual Time Burden (Hours)	300	0	0	300	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 a new collection that did not have a previous burden figure.

---

Annual Cost to Federal Government:

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

---

Common Form ICR:  No

---

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: 09/16/2008

---