INTERNational Connections

Forms and Documents

Document Name	Status
Form DS-5103 INTERNational Connections Form and Instruction	New
Final legalAuthoritiesINTERN.doc Supplementary Document	2009-11-13
INTERNationalConnectionsSupportingStatement_Update20100111.docx Supporting Statement A	2010-01-11

IC Document Collections

IC ID	Document Title	Status
191264	INTERNational Connections Form and Instruction	New

ICR Details

OMB Control No: 1405-0190	ICR Reference No: 200911-1405-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: INTERNational Connections
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/12/2010
	Date Received in OIRA: 11/16/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2013	36 Months From Approved
Responses	1,000	0	0
Time Burden (Hours)	500	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: HR/REE must collect pertinent information about current and former interns in order to keep them connected to the organization and be able to report on the intern to hire conversion. Former interns will register online at careers.state.gov/internconnect and create a profile that includes the requested information. Participants include former interns in various student programs who have completed their tenure and returned to school or other occupations but want to stay in contact with one another, as well as U.S. Department of State employees.

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Authorizing Statute(s): US Code: 22 USC 3901 Name of Law: Congressional Finding and Objectives
   US Code: 22 USC 4141a Name of Law: Foreign Servive Internship Program
  

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 119	06/23/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 218	11/13/2009
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
INTERNational Connections	DS-5103, DS-5103, DS-5103, DS-5103	Data Entry ,   INTERNagtional_Privacy Policy Screenshot ,   PRAStatement_INTERNational_Screenshot ,   Login Page

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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	1,000	0	0	1,000	0	0
Annual Time Burden (Hours)	500	0	0	500	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: New Collection

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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)? 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: 11/16/2009

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