SCSEP Performance Measurement System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ETA-9120 SPARQ Participant Data Form	Form	Modified	Available
Form ETA 9123 SPARQ Exit Form	Form	Modified	Repair queued
Form ETA 9123 SPARQ Exit Form	Form	Modified	Available
Form ETA 9122 SPARQ Unsubsidized Employment Form	Form	Modified	Available
Form ETA 9122 SPARQ Unsubsidized Employment Form	Form	Modified	Available
Form ETA-9121 SPARQ Community Service Assignment Form	Form	Modified	Repair queued
Form ETA-9121 Community Service Assignment Form	Form	Modified	Available
Form ETA 9120 SPARQ Participant Form	Form	Modified	Available
Form ETA 8705 Equitable Distribution Report Form	Form	Modified	Repair queued
Form ETA-8705 SCSEP Equitable Distribution Report	Form	Modified	Available
Form ETA 9124A Participant Customer Satisfaction Survey	Form and Instruction	Modified	Repair queued
Form ETA 9124C Employer Customer Satisfaction Survey	Form and Instruction	Modified	Available
Form ETA 9124B Host Agency Customer Satisfaction Survey	Form and Instruction	Modified	Available
1205-0040 SupportPartA 3 24 2011.doc	Supporting Statement A	Uploaded 2011-03-25	Available
1205-0040 SupportPartB_9_30_10.pdf	Supporting Statement B	Uploaded 2011-03-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43785	SCSEP Participant Data Form (State)	Form	Modified	SPARQ Participant Data Form
185407	SCSEP Four-Year State Strategy	Instruction	Modified
181013	SCSEP Exit Form (National)	Form	Modified	SPARQ Exit Form
181011	SCSEP Exit Form (State)	Form	Modified	SPARQ Exit Form
181010	SCSEP Unsubsidized Employment Form (National)	Form	Modified	SPARQ Unsubsidized Employment Form
181009	SCSEP Unsubsidized Employment Form (State)	Form	Modified	SPARQ Unsubsidized Employment Form
181008	SCSEP Community Service Assignment Form (National)	Form	Modified	SPARQ Community Service Assignment Form
181007	SCSEP Community Service Assignment Form (State)	Form	Modified	Community Service Assignment Form
180574	SCSEP Participant Data Form (National)	Form	Modified	SPARQ Participant Form
180499	SCSEP Equitable Distribution Report	Form	Modified	Equitable Distribution Report Form
180499	SCSEP Equitable Distribution Report	Form	Modified	SCSEP Equitable Distribution Report
180161	SCSEP Participant Customer Satisfaction Survey	Form and Instruction	Modified	Participant Customer Satisfaction Survey
180160	SCSEP Employer and Host Agency Customer Satisfaction Surveys	Form and Instruction	Modified	Employer Customer Satisfaction Survey
180160	SCSEP Employer and Host Agency Customer Satisfaction Surveys	Form and Instruction	Modified	Host Agency Customer Satisfaction Survey

ICR Details

OMB Control No: 1205-0040	ICR Reference No: 201103-1205-009
Status: Historical Active	Previous ICR Reference No: 200806-1205-007
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: SCSEP Performance Measurement System
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/18/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/30/2011
Terms of Clearance: The reinstatement was NOT due to a PRA violation.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	36 Months From Approved	03/31/2011
Responses	374,279	0	324,446
Time Burden (Hours)	51,179	0	45,740
Cost Burden (Dollars)	0	0	0

---

Abstract: This information collection contains program performance reports required for monitoring the Senior Community Service Employment Program (SCSEP). The current request is for approval of modified forms necessitated by the reauthorization of the SCSEP legislation (2006 Amendments to the Older Americans Act, Public Law 109-365), SCSEP Final Rule (20 CFR Part 641) and the Jobs for Veterans Act of 2002 (Public Law 07-288); an overall burden increase brought about by additional funding for additional participants; changes in overall burden for some forms based on actual usage statistics; and the requirement to publish changes to Internet-based SCSEP Performance and Results QPR (SPARQ) system that went into effect on July 1, 2010.

---

Authorizing Statute(s): PL: Pub.L. 109 - 365 501-518 Name of Law: Older Americans Act Amendments of 2006
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 365 513 Name of Law: Older Americans Act Amendments of 2006

---

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 59294	09/27/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 67120	11/01/2010
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 12

table that charts list of burden

IC Title	Form No.	Form Name
SCSEP Community Service Assignment Form (National)	ETA-9121	SPARQ Community Service Assignment Form
SCSEP Community Service Assignment Form (State)	ETA-9121	Community Service Assignment Form
SCSEP Employer and Host Agency Customer Satisfaction Surveys	ETA 9124C, ETA 9124B	Host Agency Customer Satisfaction Survey ,   Employer Customer Satisfaction Survey
SCSEP Equitable Distribution Report	ETA 8705, ETA-8705	SCSEP Equitable Distribution Report ,   Equitable Distribution Report Form
SCSEP Exit Form (National)	ETA 9123	SPARQ Exit Form
SCSEP Exit Form (State)	ETA 9123	SPARQ Exit Form
SCSEP Four-Year State Strategy
SCSEP Participant Customer Satisfaction Survey	ETA 9124A	Participant Customer Satisfaction Survey
SCSEP Participant Data Form (National)	ETA 9120	SPARQ Participant Form
SCSEP Participant Data Form (State)	ETA-9120	SPARQ Participant Data Form
SCSEP Unsubsidized Employment Form (National)	ETA 9122	SPARQ Unsubsidized Employment Form
SCSEP Unsubsidized Employment Form (State)	ETA 9122	SPARQ Unsubsidized Employment Form

---

ICR Summary of Burden

table that charts list 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	374,279	324,446	0	0	49,833	0
Annual Time Burden (Hours)	51,179	45,740	0	0	5,439	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: This is not a true re-instatement. OMB was unable to conclude ICR reference number 201010-1205-008 with an approval, because the collection also became intertwined with an NPRM and limitations within ROCIS; consequently, DOL withdrew the earlier request on March 15, 2011. This request reflects the non-NPRM provisions. Upon OMB clearance, DOL will make a subsequent request to incorporation the proposed rule. The overall burden has increased from the previously approved 46,146 hours to the current request for 51,179 hours due to added ARRA funding, which gave opportunities for additional participants to be included in the program. The reason this increase is not larger is that 1) the response data for the SPARQ and Customer Satisfaction Forms have been adjusted downward based on PY 2008 usage statistics, and the SPARQ forms ETA 9121 and ETA 9122 in the previously approved submission were inadvertently pegged at 11 minutes per form instead of 6 minutes per form, which is the stated estimated public burden for completing the form. The federal cost burden increased to $83,434 due in part to federal wage updates and because of the added program participants. In addition, ROCIS now reflects $2,900,000 in annual contractor costs (not included in ROCIS in the previous submission), for a total of $2,9083,434.

---

Annual Cost to Federal Government: $29,083,434

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 03/30/2011

---