Temporary Contractor Information Worksheet; GSA Form 850

Forms and Documents

Document Name	Status
Form GSA Form 850 Temporary Contractor Information Worksheet, GSA Form 850 Form and Instruction	Modified
Email-Erwin-10-19-09-Draft response to comment.pdf Supplementary Document	2009-11-03
3090-0283-Temporary-Comment.pdf Supplementary Document	2009-11-03
Federal Register-5-15-09.pdf Supplementary Document	2009-11-03
3090-0283-Justification.doc Supporting Statement A	2009-11-03

IC Document Collections

IC ID	Document Title	Status
188501	Temporary Contractor Information Worksheet, GSA Form 850 Form and Instruction	Modified

ICR Details

OMB Control No: 3090-0283	ICR Reference No: 200910-3090-015
Status: Historical Active	Previous ICR Reference No: 200903-3090-001
Agency/Subagency: GSA	Agency Tracking No:
Title: Temporary Contractor Information Worksheet; GSA Form 850
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: 12/08/2009
	Date Received in OIRA: 11/04/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2012	36 Months From Approved	12/31/2009
Responses	24,480	0	24,480
Time Burden (Hours)	6,120	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: GSA requires the collection of the information in the Temporary Contractor Information Worksheet to authorize and initiate investigation requests for GSA temporary contractors on GSA contracts related to the American Recovery and Reinvestment Act of 2009 to grant unescorted access to GSA-controlled facilities. The background investigations and adjudication of results are carried out by the US Department of Homeland Security, Immigration and Customs Enforcement, Federal Protective Service (DHS/ICE/FPS) Contractor Suitability and Adjudication Division in accordance with the terms and conditions of separate Memoranda of Agreement with GSA.

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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:
	74 FR 22930	05/15/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 57177	11/04/2009
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Temporary Contractor Information Worksheet, GSA Form 850	GSA Form 850	Temporary Contractor Information Worksheet

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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	24,480	24,480	0	0	0	0
Annual Time Burden (Hours)	6,120	0	0	6,120	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: There were no changes to this burden. The first request was an emergency request due to the American Recovery and Reinvestment Act of 2009.

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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)? Yes

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: 11/03/2009

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