Senior Community Service Employment Program Performance Measurement System

Forms and Documents

Document Name	Status
Form ETA 9120 SCSEP Participant Data Form (State) Form	Modified
Form ETA-9123 SCSEP Exit Form (National) Form	Modified
Form ETA 9123 SCSEP Exit Form (State) Form	Modified
Form ETA-9122 SCSEP Unsubsidized Employment Form (National) Form	Modified
Form ETA-9122 SCSEP Unsubsidized Employment Form (State) Form	Modified
Form ETA 9121 SCSEP Community Service Assignment Form (National) Form	Modified
Form ETA 9121 SCSEP Community Service Assignment Form (State) Form	Modified
Form ETA 9120 SCSEP Participant Data Form (National) Form	Modified
Form ETA-8705 SCSEP Equitable Distribution Report Form	Modified
Form ETA-9124 SCSEP Participant Customer Satisfaction Survey Form and Instruction	Modified
Form ETA 9124B SCSEP Employer and Host Agency Customer Satisfaction Surveys Form and Instruction	Modified
1205-0040_SupportPartA 9 2 2011.doc Supporting Statement A	2011-09-12
1205-0040 SupportPartB_9_30_10.pdf Supporting Statement B	2011-03-16

IC Document Collections

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

ICR Details

OMB Control No: 1205-0040	ICR Reference No: 201203-1205-010
Status: Historical Active	Previous ICR Reference No: 201103-1205-009
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: Senior Community Service Employment Program Performance Measurement System
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: 03/29/2012
	Date Received in OIRA: 03/29/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved	04/30/2014
Responses	374,279	0	374,279
Time Burden (Hours)	53,346	0	51,179
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection contains program performance reports required for monitoring the Senior Community Service Employment Program (SCSEP). The current request is for an extension with the addition of a request for approval of an additional participant data indicator: participants' volunteer efforts.

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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

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1205-AB60	Final or interim final rulemaking	77 FR 4654	01/31/2012

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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

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

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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	374,279	374,279	0	0	0	0
Annual Time Burden (Hours)	53,346	51,179	0	1,000	1,167	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 overall burden has increased slightly to 53,346 hours due to added burden for the Exit Form – ETA-9123 - which collects data for the added indicator on volunteer work, and a calculation adjustment for one of the forms from 6 minutes to 10 minutes in burden (ETA-9124A). The federal cost burden increased to $83,434 due in part to federal wage updates and because of the added program participants. In addition, note that ROCIS now also reflects $2,900,000 in annual contractor costs (not included in ROCIS in the previous submission), for a total of $2,984,573.

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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

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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: 01/26/2012

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