Application for Financing

Forms and Documents

Document Name	Status
OPIC Form 115 revised 2012.docx Supporting Statement B	2012-03-28
2012-OPIC-115 Supporting Statement .docx Supporting Statement A	2012-03-28

IC Document Collections

IC ID	Document Title	Status
201722	Application for Financing	New

ICR Details

OMB Control No: 3420-0015	ICR Reference No: 201203-3420-002
Status: Historical Inactive	Previous ICR Reference No: 201107-3420-006
Agency/Subagency: OPIC	Agency Tracking No: OPIC-115
Title: Application for Financing
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 05/15/2012
	Date Received in OIRA: 03/28/2012
Terms of Clearance: This collection was inadvertently submitted as a “generic request”. It should be resubmitted as a regular request.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2014	36 Months From Approved	09/30/2014
Responses	150	0	150
Time Burden (Hours)	293	0	293
Cost Burden (Dollars)	0	0	0

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Abstract: Under the authority for information collection: Section 231 and 234(b) and (c) of the Foreign Assistance Act of 1961, as amended; OPIC-115 is used to determine the investor's and project eligibility for debt financing; environmental impact, and developmental effects of the projects; measure the economic effects for the U.S. and host country; and assess certain workers right information. This from has been revised to make it shorter and also electronic.

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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 73741	12/29/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 4373	01/27/2012
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
Application for Financing

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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: No

Burden Reduction Due to:

Short Statement: The agency is changing to a totally electronic form.

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Annual Cost to Federal Government: $12,602

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? Yes

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: 03/28/2012

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