Applicant Background Survey

Forms and Documents

Document Name	Status
Form DI 1935 Applicant Background Survey Form and Instruction	Modified
30 Day Notice.pdf Supplementary Document	2009-04-10
App. Bckgrnd. Surv. Supporting Statement - PART A.doc Supporting Statement A	2009-04-06
29 CFR 1602.htm Supplementary Document	2009-04-01
US CODE Title 42,2000e�4_ Equal Employment Opportunity Commission.htm Supplementary Document	2009-04-01
5 USC 7201.txt Supplementary Document	2009-04-01
60 Day Notice 73 FR 72518.pdf Supplementary Document	2009-04-01
Supporting Statement PART B.doc Supporting Statement B	2009-04-01

IC Document Collections

IC ID	Document Title	Status
11577	Applicant Background Survey Form and Instruction	Modified

ICR Details

OMB Control No: 1091-0001	ICR Reference No: 200903-1091-001
Status: Historical Active	Previous ICR Reference No: 200603-1091-001
Agency/Subagency: DOI/OEO	Agency Tracking No:
Title: Applicant Background Survey
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 without change	Conclusion Date: 07/10/2009
	Date Received in OIRA: 04/10/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2012	36 Months From Approved	07/31/2009
Responses	335,820	0	535,160
Time Burden (Hours)	11,194	0	26,758
Cost Burden (Dollars)	0	0	0

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Abstract: The collection of personal background data on job applicants is for purposes of planning and assessing affirmative employment program initiatives. Under these procedures, applicants and selectees are requested to provide, on a purely voluntary basis, information on their race, ethnic origin, gender, and disability to help ensure Department personnel practices meet the requirements of Federal law.

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Authorizing Statute(s): US Code: 5 USC Chapter 72, Section 7201 Name of Law: Antidiscrimination Policy
   US Code: 42 USC 2000e Name of Law: Civil Rights Act
  

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 72518	11/28/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 16415	04/10/2009
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 Survey	DI 1935	Applicant Background Survey

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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	335,820	535,160	0	0	-199,340	0
Annual Time Burden (Hours)	11,194	26,758	0	0	-15,564	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: There is a decrease in the burden because of two factors. One is the use of automated submission of the form has reduced the estimated time to complete the form. Secondly, there have been fewer job applicants for positions advertised, reducing the overall number of forms submitted.

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Annual Cost to Federal Government: $45,192

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)? 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: 04/10/2009

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