Application for Senior Administrative Law Judge & Geographic Preference Statement for Senior Administrative Law Judge

Forms and Documents

Document Name	Status
Form OPM 1655A Geographic Preference Statement for Senior Administrative Law Judge Applicant Form and Instruction	Unchanged
Form OPM 1655 Application for Senior Administrative Law Judge Form and Instruction	Unchanged
Supp_Stat.DOC Supporting Statement A	2007-10-17

IC Document Collections

IC ID	Document Title	Status
182393	Geographic Preference Statement for Senior Administrative Law Judge Applicant Form and Instruction	Unchanged
182362	Application for Senior Administrative Law Judge Form and Instruction	Unchanged

ICR Details

OMB Control No: 3206-0248	ICR Reference No: 201101-3206-001
Status: Historical Active	Previous ICR Reference No: 200710-3206-001
Agency/Subagency: OPM	Agency Tracking No:
Title: Application for Senior Administrative Law Judge & Geographic Preference Statement for Senior Administrative Law Judge
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 01/19/2011
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/08/2011
	Date Received in OIRA: 01/19/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2011	6 Months From Approved
Responses	350	0	0
Time Burden (Hours)	163	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: OPM 1655 and OPM 1655A will be used by retired Administrative Law Judges seeking reemployment to complete hearings in accordance with the Administrative Procedures Act of 1946. These forms will streamline the application process by providing all needed information on 2 forms.

Emergency Justfication: This is to request an emergency extension for OPM Forms 1655 and 1655-A, OMB Control Number: 3206-0248. On October 7, 2010, the Office of Personnel Management (OPM) published a 60-day Federal Register Notice Vol. 75, No. 194 regarding a proposed rule to permanently eliminate the licensure requirement for incumbent Administrative Law Judges (ALJs) covered under the ALJ Program. Comments regarding this proposed rule are due on December 6, 2010. The rules concerning licensure requirements for incumbent ALJs may change, and could have a direct link to Senior ALJs, who utilize these forms to apply for the Senior ALJ Program. The final rule may greatly impact the Senior ALJ Program as the forms will require that revisions be made once the rule becomes final. As such, we are requesting a 6-month emergency extension based on the outcome of rulemaking. We presently anticipate that, at a minimum, a 6-month extension will be needed for an adequate time for OPM to evaluate public comments on the proposed rule and to revise the forms, as necessary, in conjunction with issuing the final rule. The expiration of these forms will cause unnecessary burden to retired ALJs, as the forms are tailored toward the specific requirements of the Senior ALJ Program, and eliminate the need to solicit additional information from Senior ALJ applicants.

---

Authorizing Statute(s): US Code: 5 USC 3323(b) Name of Law: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Geographic Preference Statement for Senior Administrative Law Judge Applicant	OPM 1655A	Geographic Preference Statement for Senior Administrative Law Judge Applicant
Application for Senior Administrative Law Judge	OPM 1655	Application for Senior Administrative Law Judge

---

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	350	0	0	0	0	350
Annual Time Burden (Hours)	163	0	0	0	0	163
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:

---

Annual Cost to Federal Government: $59,219

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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: 01/19/2011

---