Applicant Background Questionnaire

Forms and Documents

Document Name	Status
Form HR-1225-0072 Applicant Background Questionaire - USDA Form	Modified
Form HR-1225-0072 Applicant Background Questionnaire - DOL Form	Modified
Supporting Statement (1225-0072)_rev_9-9-09.doc Supporting Statement A	2009-09-09
Associate Attorney General Memo.pdf Supplementary Document	2008-10-09
60-day FRN (1225-0072).pdf Supplementary Document	2008-10-09

IC Document Collections

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

ICR Details

OMB Control No: 1225-0072	ICR Reference No: 200810-1225-001
Status: Historical Active	Previous ICR Reference No: 200708-1225-002
Agency/Subagency: DOL/DM	Agency Tracking No:
Title: Applicant Background Questionnaire
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: 09/28/2009
	Date Received in OIRA: 10/23/2008
Terms of Clearance: Per agreement with EEOC, DOL has removed the disability questions from this collection pending additional interagency work to improve the targeted disabilities categories.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2012	36 Months From Approved	09/30/2009
Responses	20,500	0	5,000
Time Burden (Hours)	1,608	0	250
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, 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
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 43476	07/25/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 63199	10/23/2008
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 - USDA	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	20,500	5,000	0	0	15,500	0
Annual Time Burden (Hours)	1,608	250	0	0	1,358	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: The burden hours for this collection have increased from 250 hours to 1,608 hours. The increase in burden represents a net change of 1,358 hours. In addition, the number of responses has increased from 5,000 to 20,500. This represents a net change of 15,500 responses. The increase is due to USDA’s proposed use of the form (+1,458 hours and +17,500 responses) and the Nuclear Regulatory Agency’s discontinued use (-100 hours and -2,000 responses).

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Annual Cost to Federal Government: $1,137

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: 10/23/2008

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