SUPPORTING STATEMENT FOR THE
Ombudsman Request for Assistance
OMB #3206-NEW
Justification:
Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection.
The information collected on this form is used to identify any concerns or complaints involving customers and employees of federal government agencies. The U.S. Office of Personnel Management (OPM) is authorized to request this information under the Office of the Ombudsman in the Office of the Executive Secretariat and Ombudsman, in order to provide a neutral, independent and confidential resource.
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.
The OPM 1747 is completed by the customer or employee requesting the Ombudsman’s assistance to raise or resolve their issue or complaint. It is a fillable form that collects information about the nature of their complaint and contact information. The information collected on this form is mainly used to identify the issue and provide a resolution. However, if necessary, and usually in conjunction with another form or forms, the information on this form may be used to assist the Ombudsman’s office in determining the appropriate action and in order to provide a resolution to the customer’s request.
This information is collected by the Ombudsman’s office staff professionals during the initial request for assistance.
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 burden.
The collection of information does involve automated, electronic, mechanical or other technical collection techniques. Although, it is available over the internet, the OPM 1747 must be submitted by the customer or employee.
Describe efforts to identify duplication.
Information collected on the OPM 1747 about the nature of a complaint and contact information is used to identify the issue and provide a resolution. Other forms, specifically the OPM 1743 and OPM 1744, may request similar information, but these information collections are for the purpose of giving third party authorization and privacy release, each as appropriate, in order to provide a resolution.
If the collection of information impacts small businesses or other small entities (Item 5 of OMB Form 83-I), describe any methods used to minimize burden.
This collection of information does not affect small businesses or other small entities.
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.
The OPM 1747 is completed by the customer or employee requesting assistance of the Ombudsman’s office to raise or resolve an issue or complaint. The OPM 1747 requests that the customer or employee provide personal identifying data, including civil service numbers and/or social security numbers.
If this information is not collected, the Ombudsman’s office would be unable to assist the customer or employee in resolving their issue or complaint in the most expeditious manner.
Explain any special circumstances that would cause an information collection to be conducted in a manner inconsistent with the guidelines in 5 CFR 1320.6.
Not applicable. This information collection is in compliance with 5 CFR 1320.6.
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.
A notice of the proposed information collection was published in the Federal Register on August 10th, 2010 at 75 FR 48383. No comments were received.
Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.
Not applicable. Customers or employees voluntarily complete these forms.
Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy.
The OPM 1743, OPM 1744, and OPM 1747 contain a Privacy Act Statement.
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.
Not applicable. The questions are not of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private.
Provide estimates of the hour burden of the collection of information.
It is estimated that the Privacy Release form will take approximately 5 minutes; the Third Party Authorization form will take approximately 10 minutes; and the web enabled Request for Assistance will take approximately 15 minutes to complete. If all three forms are used it is estimated to take an average of 30 minutes to complete.
Provide an estimate for the total annual cost burden to respondents or record keepers resulting from the collection of information.
There is no cost to individual respondents.
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 expenses that would not have been incurred without the paperwork burden.
It is estimated that the cost to print and maintain the OPM 1747, OPM 1743, and OPM 1744 forms are $1,440. This figure is based on the annual total of OPM 1747, OPM 1743, and OPM 1744 used (12,000) x cost per form (0.12) = $1,440.
Explain the reasons for any program changes or adjustments reported in Items 13 or 14 of the OMB Form 83-I.
The overall annual public burden hours for the OPM 1747 are 2,000 hours. This figure has been calculated utilizing the subsequent parameters: 4,000 (number of respondents) x 30 minutes (approximate time to complete the forms) =120,000 minutes / 60 minutes = 2,000 hours (annual public burden hours).
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 schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.
Not applicable. Information collected on the forms will not be published.
If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.
Not applicable.
Explain each exception to the certification statement identified in Item 19, "Certification for Paperwork Reduction Act Submissions," of OMB Form 83-I.
Not applicable.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | OMB Supporting Statement |
| Author | GLiddy |
| File Modified | 0000-00-00 |
| File Created | 2021-02-01 |