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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OPM 1655A Geographic Preference Statement for Senior Administrative Law Judge Applicant	Form and Instruction	Modified	Available
Form OPM 1655 Application for Senior Administrative Law Judge	Form and Instruction	Modified	Repair queued
30 day published.pdf	Supplementary Document	Uploaded 2011-08-16	Available
Supporting Statement_ALG 2011 update.doc	Supporting Statement A	Uploaded 2011-08-15	Available
60 day published.pdf	Supplementary Document	Uploaded 2011-08-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
182393	Geographic Preference Statement for Senior Administrative Law Judge Applicant	Form and Instruction	Modified
182362	Application for Senior Administrative Law Judge	Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0248	ICR Reference No: 201108-3206-001
Status: Historical Active	Previous ICR Reference No: 201101-3206-001
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: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/07/2011
	Date Received in OIRA: 08/16/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	36 Months From Approved	10/31/2011
Responses	250	0	350
Time Burden (Hours)	138	0	163
Cost Burden (Dollars)	0	0	0

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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. The forms are not changing however the burden has decreased due to a decreased respondent pool.

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

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 25379	05/04/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 50769	08/16/2011
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

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

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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	250	350	0	-100	0	0
Annual Time Burden (Hours)	138	163	0	-25	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: respondent pool has decreased from previous estimates and submissions.

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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

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Common Form ICR:  No

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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: 08/16/2011

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