SS_1218-0255-Conflict of Interest Form (05-13-10)

SUPPORTING STATEMENT FOR THE
INFORMATION COLLECTION REQUIREMENTS OF THE
CONFLICT OF INTEREST (COI) AND DISCLOSURE FORM 1
OFFICE OF MANAGEMENT AND BUDGET (OMB)
CONTROL NUMBER 1218-0255 (May 2010)

Justification
1.

Explain the circumstances that make the collection of information necessary. Identify any legal or
administrative requirements that necessitate the collection. Attach a copy of the appropriate section of
each statute and regulation mandating or authorizing the collection of information.

The Office of Management and Budget (OMB) published the Final Information Quality Bulletin
for Peer Review on December 15, 2004. The Bulletin established that important scientific
information shall be peer reviewed by qualified specialists before it is disseminated by the
federal government. Peer review is one of the important procedures used to ensure that the
quality of published information meets the standards of the scientific and technical community.
It is a form of deliberation involving an exchange of judgments about the appropriateness of
methods and the strength of the author’s inferences. Peer review involves the review of a draft
product for quality by specialists in the field who were not involved in producing the draft.
Some federal agencies make use of peer review to obtain evaluations of draft information that
contains important scientific determinations. The selection of participants in a peer review is
based on expertise, with due consideration of independence and conflict of interest. The Bulletin
states “…the agency must address reviewers’ potential conflicts of interest (including those
stemming from ties to regulated businesses and other stakeholders) and independence from the
agency. This Bulletin requires agencies to adopt or adapt the committee selection policies
employed by the National Academy of Sciences (NAS) when selecting peer reviewers who are
not government employees.” The NAS employs a Conflict of Interest Disclosure form to
determine whether or not a conflict of interest exists for a provisional committee member.
A copy of the OMB Final Information Quality Bulletin for Peer Review, Introduction is attached.
2.

Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection,
indicate the actual use the agency has made of the information received from the current collection.

OSHA’s Contractor obtains background information and conflict of interest information using a
standardized format, referred to as the Conflict of Interest (COI) form to determine if the
potential peer reviewers will not be compromised by a significant conflict of interest. The term
“conflict of interest” means any financial or other interest that conflicts with the service of the
individual because 1) it could significantly impair the individual’s objectivity or 2) it could
create an unfair competitive advantage for any person or organization. Except for those
1

The purpose of this Supporting Statement is to analyze and describe the burden hours and cost associated
with provisions of this standard that contain paperwork requirements; this Supporting Statement does not provide
information or guidance on how to comply with, or how to enforce, these provisions.

situations in which OSHA determines that a conflict of interest is unavoidable and promptly and
publicly discloses the COI, no individual can be selected to serve as a peer reviewer for OSHA if
the individual has a COI that is relevant to the functions/services performed.
OSHA has short and long versions of the COI form. For some reviews, potential peer reviewers
complete the short COI form. The questions on the short form elicit a yes/no answer and only
require further response if a potential conflict is identified. In other cases, potential peer
reviewers are required to complete the long version of the COI form, providing more detailed
information on areas of potential conflict such as employment, research funding, and assets as
well as answering the same questions that are on the short version of the form.
The completed COI form is returned by the potential peer reviewer to the OSHA contractor. The
contractor reviews the responses and determines whether potential peer reviewers have any
conflicts of interest. The contractor then convenes the peer review panel.
3. Describe whether, and to what extent, the collection of information involves the use of automated,
electronic, mechanical, or other technological collection techniques or other forms of information technology,
e.g., permitting electronic submission of responses, and the basis for the decision for adopting this means of
collection. Also, describe any consideration of using information technology to reduce burdens.

The respondents receive the COI form as an attachment to an email from the OSHA contractor.
The respondents return the completed form as an email attachment, by mailing a hard copy to the
contractor, or by fax.
4. Describe efforts to identify duplication. Show specifically why any similar information already available
cannot be used or modified for use for the purposes described in Item A.2 above.

The information required to be collected and maintained is specific to each invited expert and is
not available or duplicated by another source. The information requested for the background
information and conflict of interest disclosure is available only from the invited expert.
5. If the collection of information impacts small businesses or other small entities, describe any methods used
to minimize burden.

No small businesses are involved. Requested information is provided from persons as potential
expert witnesses, not as a small business.
6. Describe the consequence to Federal program or policy activities if the collection is not conducted or is
conducted less frequently, as well as any technical or legal obstacles to reducing burden.

7. Explain any special circumstances that would cause an information collection to be conducted in a
manner:
•

requiring respondents to report information to the agency more often than quarterly;

•

requiring respondents to prepare a written response to a collection of information in fewer than
30 days after receipt of it;

•

requiring respondents to submit more than an original and two copies of any document;

2

•

requiring respondents to retain records, other than health, medical, government contract, grantin-aid, or tax records, for more than three years;

•

in connection with a statistical survey that is not designed to produce valid and reliable results
that can be generalized to the universe of study;

•

requiring the use of a statistical data classification that has not been reviewed and approved by
OMB;

•

that includes a pledge of confidentiality that is not supported by authority established in statute
or regulation, that is not supported by disclosure and data security policies that are consistent
with the pledge, or which unnecessarily impedes sharing of data with other agencies for
compatible confidential use; or

•

requiring respondents to submit proprietary trade secret, or other confidential information
unless the agency can demonstrate that it has instituted procedures to protect the information's
confidentiality to the extent permitted by law.

Respondents may need to complete the COI form in fewer than 30 days after receipt of the form,
depending on the timeframes that are tailored to each peer review panel. When possible,
respondents will be provided 30 days or more to complete the form.
Under terms of the contract, OSHA’s contractor keeps the completed COI forms confidential.
See Item 10 of this Supporting Statement for further discussion of confidentiality agreements.
8. If applicable, provide a copy and identify the date and page number of publication in the Federal Register
of the agency's notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior
to submission to OMB. Summarize public comments received in response to that notice and describe actions
taken by the agency in response to these comments. Specifically address comments received on cost and hour
burden.
Describe efforts to consult with persons outside the agency to obtain their views on the availability of data,
frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting format (if any),
and on the data elements to be recorded, disclosed, or reported.
Consultation with representatives of those from whom information is to be obtained or those who must
compile records should occur at least once every 3 years -- even if the collection of information activity is the
same as in prior periods. There may be circumstances that may preclude consultation in a specific situation.
These circumstances should be explained.

As required by the Paperwork Reduction Act of 1995 (44 U.S.C. 3506(c)(2)(A)), OSHA
published a notice in the Federal Register on February 19, 2010 (75 FR 7522, Docket No.
OSHA-2009-0042) requesting public comment on its proposal to extend the Office of
Management and Budget’s (OMB) approval of the information collection requirement specified
by the Conflict of Interest (COI) and Disclosure Form. This notice was part of a preclearance
consultation program that provided the general public and government agencies with an
opportunity to comment. The Agency received no comments in response to its notice.
9. Explain any decision to provide any payment or gift to respondents, other than reenumeration of
contractors or grantees.

3

The Agency will not provide payments or gifts to the respondents.
10. Describe any assurance of confidentiality provided to respondents and the
basis for the assurance in statute, regulation, or agency policy.

There are no assurances of confidentiality provided to respondents based in statute, regulation or
agency policy; however, under terms of the contract, OSHA’s contractor must keep the
completed COI forms confidential.
OSHA’s contractor routinely collects, handles, and stores conflict-of-interest (COI) information
while conducting peer review and peer consultation tasks for federal agencies. When identifying
experts to review any document designated by the agency as a “highly influential scientific
assessment (HISA),” the contractor requires candidate reviewers to provide COI information that
they may consider to be confidential, such as financial holdings, investments, property holdings,
etc., in order to determine the potential for a COI.
To maintain the confidentiality of all such COI information, the contractor requires all staff who
receive or handle such information to sign confidentiality agreements that require them to adhere
to the following procedures:
(i)

The COI form shall be used only for the purposes of carrying out the work required
for the peer review or consultation;

(ii)

The staff shall not disclose, discuss, or disseminate the information to or with anyone,
both during the project and after the review or consultation is completed, unless that
person is a staff person for the same contractor who has signed a confidentiality
agreement;

(iii)

The staff working on the peer review/consultation project shall exercise due diligence
in safeguarding and handling the COI forms and information the entire time it is in
their possession;

(iv)

The contractor shall not make any copies (including paper copies and electronic
copies) of any part of the COI form, except for the original paper copy for the project
files;

(v)

The contractor shall not share COI information with the contracting agency or any
outside entities, except as required to do so by law or as requested as part of a formal
investigation by the Office of Inspector General, General Accountability Office,
Congressional Committee;

(vi)

The contractor’s project manager shall store the electronic copy of the COI form only
on her/his individual password-protected work computer and only until the project is
completed, at which point the electronic copy shall be deleted; and

4

(vii)

While the project is underway, the contractor’s project manager shall store the COI
forms in the individual task files, to be kept in locked file cabinets. When the project
is complete, the files shall be stored in archival boxes in a secure off-site location.

11. Provide additional justification for any questions of a sensitive nature, such as sexual behavior and
attitudes, religious beliefs, and other matters that are commonly considered private. This justification should
include the reasons why the agency considers the questions necessary, the specific uses to be made of the
information, the explanation to be given to persons from whom the information is requested, and any steps to
be taken to obtain their consent.

There are no questions of a sensitive nature on the COI form.
12. Provide estimates of the hour burden of the collection of information. The statement should:


Indicate the number of respondents, frequency of response, annual hour burden, and an explanation
of how the burden was estimated. Unless directed to do so, agencies should not conduct special
surveys to obtain information on which to base hour burden estimates. Consultation with a sample
(fewer than 10) of potential respondents is desirable. If the hour burden on respondents is expected
to vary widely because of differences in activity, size, or complexity, show the range of estimated
hour burden, and explain the reasons for the variance. Generally, estimates should not include
burden hours for customary and usual business practices.



If this request for approval covers more than one form, provide separate hour burden estimates for
each form and aggregate the hour burdens.



Provide estimates of annualized cost to respondents for the hour burdens for collections of
information, identifying and using appropriate wage rate categories. The cost of contracting out or
paying outside parties for information collection activities should not be included here. Instead, this
cost should be included in Item 14.

Based on the number of OSHA products reaching the peer review stage per year for the last
several years, OSHA estimates that there will be two peer review panels convened per year.
OSHA estimates that for one of the peer review panels, the potential peer reviewers will be
required to complete the short COI form. For the other panel the potential peer reviewers will be
required to complete the long version of the COI form. For each peer review panel (that will
have 6-9 members), OSHA estimates that the COI form will be sent to 18 potential peer
reviewers.
Short Version of COI Form:
OSHA estimates that it will take 0.5 hours to complete the short version of the COI form. Thus,
in each year, 18 respondents will each spend 0.5 hours for a total of 9 hours completing the short
version of the COI form.
Long Version of COI Form:
OSHA estimates that it will take 18 respondents 1.0 hour to complete the long version of the COI
form, totaling 18 hours per year.

5

In summary, OSHA estimates that the total hours spent per year completing the COI form will be
27 hours.
The potential peer reviewers will all be senior scientists with a wage rate of $100 per hour.
Thus, OSHA estimates that the annual total cost burden to the respondents will be $2,700.
13. Provide an estimate of the total annual cost burden to respondents or recordkeepers resulting from the
collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).
•

The cost estimate should be split into two components: (a) a total capital and start-up cost
component (annualized over its expected useful life); and (b) a total operation and maintenance and
purchase of services component. The estimates should take into account costs associated with
generating, maintaining, and disclosing or providing the information. Include descriptions of
methods used to estimate major cost factors including system and technology acquisition, expected
useful life of capital equipment, the discount rate(s), and the time period over which costs will be
incurred. Capital and start-up costs include, among other items, preparations for collecting
information such as purchasing computers and software; monitoring, sampling, drilling and testing
equipment; and record storage facilities.

•

If cost estimates are expected to vary widely, agencies should present ranges of cost burdens and
explain the reasons for the variance. The cost of purchasing or contracting out information
collection services should be a part of this cost burden estimate. In developing cost burden estimates,
agencies may consult with a sample of respondents (fewer than 10), utilize the 60-day pre-OMB
submission public comment process and use existing economic or regulatory impact analysis
associated with the rulemaking containing the information collection, as appropriate.

•

Generally, estimates should not include purchases of equipment or services, or portions thereof,
made: (1) prior to October 1, 1995, (2) to achieve regulatory compliance with requirements not
associated with the information collection, (3) for reasons other than to provide information or keep
records for the government, or (4) as part of customary and usual business or private practices.

The cost determined under Item 12 accounts for the total annual cost burden to the potential peer
reviewers resulting from these collection of information requirements.
14. Provide estimates of annualized cost to the Federal government. Also, provide a description of the
method used to estimate cost, which should include quantification of hours, operational expenses (such as
equipment, overhead, printing, and support staff), and any other expense that would not have been incurred
without this collection of information. Agencies also may aggregate cost estimates from Items 12, 13, and 14
in a single table.

Based on discussion with the contractor, OSHA estimates that it will cost $26 per respondent for
the contractor to conduct the background information and conflict of interest disclosure process.
Thus, with 36 respondents per year, the total cost will be $936.
15. Explain the reasons for any program changes or adjustments.

There will be no change in burden hours for obtaining the necessary background information and
disclosure of conflict of interest information to ensure that invited experts are not compromised.
There are no costs as discussed under Item 13 of the Supporting Statement.
16. For collections of information whose results will be published, outline plans for tabulation, and
publication. Address any complex analytical techniques that will be used. Provide the time scheduled for the

6

entire project, including beginning and ending dates of the collection of information, completion of report,
publication dates, and other actions.

OSHA will not publish the information collected as a result to the Conflict of Interest, Disclosure
form.
17. If seeking approval to not display the expiration date for OMB approval of the information collection,
explain the reason that display would be inappropriate.

OSHA will display the OMB and expiration date in the Background Information and Conflict of
Interest Disclosure package.
18. Explain each exception to the certification statement.

OSHA is not seeking an exception to the certification statement.

7