Interview Survey Form (INV 10)

Forms and Documents

Document Name	Status
Form INV 10 Interview Survey Form Form and Instruction	Modified
30 day notice INV 10.pdf Supplementary Document	2012-04-30
60 day INV 10.pdf Supplementary Document	2012-04-30
SSA3206-0106 for 30 apr.DOC Supporting Statement A	2012-04-30

IC Document Collections

IC ID	Document Title	Status
33582	Interview Survey Form Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0106	ICR Reference No: 201112-3206-004
Status: Historical Active	Previous ICR Reference No: 200901-3206-002
Agency/Subagency: OPM	Agency Tracking No:
Title: Interview Survey Form (INV 10)
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: 08/02/2012
	Date Received in OIRA: 04/30/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	36 Months From Approved	08/31/2012
Responses	63,869	0	50,000
Time Burden (Hours)	6,387	0	5,000
Cost Burden (Dollars)	0	0	0

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Abstract: To provide feedback and ensure the accuracy, integrity, and professionalism of investigators assigned to perform background investigations on behalf of the Office of Personnel Management (OPM).

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Authorizing Statute(s): EO: EO 10450 Name/Subject of EO: null
   EO: EO 12968 Name/Subject of EO: 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:
	77 FR 5581	02/03/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 25506	04/30/2012
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Interview Survey Form	INV 10	Interview Survey Form

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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	63,869	50,000	0	13,869	0	0
Annual Time Burden (Hours)	6,387	5,000	0	1,387	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: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in burden resulted from an increase in the number of Background Investigations conducted.

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Annual Cost to Federal Government: $111,174

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: 04/30/2012

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