Applicant Questionnaire: Race, National Origin, Gender, and Disability Demographics

Forms and Documents

Document Name	Status
Form UnNumbered Demographic Information on Applicants Form	New
Form 3-378 Applicant Questionnaire, Race, National Origin, Gender and Disability Demographics Form	Removed
1110-0047 Supporting_Statement.doc Supporting Statement A	2012-08-23
3-873Signature.pdf Supplementary Document	2011-12-15
3-873-83I.pdf Supplementary Document	2011-12-15
29 CFR Section 1614_601 EEO group statistics.wpd Supplementary Document	2008-09-22

IC Document Collections

IC ID	Document Title	Status
203834	Demographic Information on Applicants Form	New
184115	Applicant Questionnaire, Race, National Origin, Gender and Disability Demographics Form	Removed

ICR Details

OMB Control No: 1110-0047	ICR Reference No: 201111-1110-001
Status: Historical Active	Previous ICR Reference No: 200806-1110-001
Agency/Subagency: DOJ/FBI	Agency Tracking No:
Title: Applicant Questionnaire: Race, National Origin, Gender, and Disability Demographics
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/03/2012
	Date Received in OIRA: 03/08/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2015	36 Months From Approved	08/31/2012
Responses	455,919	0	158,403,960
Time Burden (Hours)	0	0	30,462
Cost Burden (Dollars)	0	0	0

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Abstract: Under the authority of the EEOC Management Directive (MD) 715, the Human Resources Division is requesting demographic information from applicants applying for employment with the FBI. Without the requested data, the FBI would be in a position of non-compliance with MD-715.

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Authorizing Statute(s): None

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 80965	12/27/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 13151	03/05/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Demographic Information on Applicants	UnNumbered	Demographic Information on Applicant
Applicant Questionnaire, Race, National Origin, Gender and Disability Demographics	3-378	Applicant Questionnaire

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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	455,919	158,403,960	0	0	-157,948,041	0
Annual Time Burden (Hours)	0	30,462	0	0	-30,462	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: There are no changes to this collection that are of a programmatic nature. The burden estimates are changing because the FBI is utilizing the common form provided by EEOC under OMB control number 3046-0046. Because the EEOC collection accounts for the burden for all agencies to use the form, this collection request imposes no new burden.

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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

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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: 03/08/2012

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