Various contract related forms that will be included in the Homeland Security Acquisition Regulation

Forms and Documents

Document Name	Status
Form DHS 700-1 Cumulative Claim and Reconciliation Statement Form	Modified
Form DHS 700-4 Employee Claim for Wage Restitution Form	Modified
Form DHS 700-3 Contractor's Release Form	Modified
Form DHS 700-2 Contract Assignment of Refunds, Rebates, Credits and Other Amounts Form	Modified
30 Day FRN 1600 0002.pdf Supplementary Document	2011-02-24
60 Day FRN 1600 0002.pdf Supplementary Document	2011-02-24
Supporting Statement 1600 0002.docx Supporting Statement A	2011-02-24
FAR 48 CFR.pdf Supplementary Document	2007-12-17
HSAR-0606.pdf Supplementary Document	2007-12-12

IC Document Collections

IC ID	Document Title	Status
20201	Cumulative Claim and Reconciliation Statement Form	Modified
182985	Employee Claim for Wage Restitution Form	Modified
182984	Contractor's Release Form	Modified
182983	Contract Assignment of Refunds, Rebates, Credits and Other Amounts Form	Modified

ICR Details

OMB Control No: 1600-0002	ICR Reference No: 201102-1600-002
Status: Historical Active	Previous ICR Reference No: 200712-1600-002
Agency/Subagency: DHS	Agency Tracking No:
Title: Various contract related forms that will be included in the Homeland Security Acquisition Regulation
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: 05/12/2011
	Date Received in OIRA: 02/28/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	36 Months From Approved	05/31/2011
Responses	8,635	0	7,101
Time Burden (Hours)	8,635	0	7,101
Cost Burden (Dollars)	0	0	0

---

Abstract: During contract administration, there may be instances where a contractor or the contractor's employee requires submission of one ofthe forms; or the form may be necessary to implement Federal statute/regulation.

---

Authorizing Statute(s): US Code: 41 USC 401 Name of Law: Office of Federal Procurement Policy Act of 1974
  

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
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 69688	11/15/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 10385	02/24/2011
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Contract Assignment of Refunds, Rebates, Credits and Other Amounts	DHS 700-2	Contractors Assignment of Refunds, Rebates, Credits, and Other Amounts
Contractor's Release	DHS 700-3	Contractor's Release
Cumulative Claim and Reconciliation Statement	DHS 700-1	Cumulative Claim and Reconciliation Statement
Employee Claim for Wage Restitution	DHS 700-4	Employee Claim for Wage Restitution

---

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	8,635	7,101	0	0	1,534	0
Annual Time Burden (Hours)	8,635	7,101	0	0	1,534	0
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: There has been an increase in the estimated annual burden hours previously reported for this collection. An adjustment in annual burden is necessary at this time in the amount of 1534 actions and hours. The initial annual burden was based on a lower number of contract actions which related to the fact that DHS was a new agency with consolidated acquisition procedures, processes, and policies. Although, there is an increase in the estimated burdened hours, there is no change in the information being collected.

---

Annual Cost to Federal Government: $0

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: 02/28/2011

---