Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled

Forms and Documents

Document Name	Status
Form 404 Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled Form	Modified
Committee Regulations on compliance.docx Supporting Statement B	2012-07-30
Supporting Statement 404 2012.docx Supporting Statement A	2012-07-30

IC Document Collections

IC ID	Document Title	Status
28982	Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled Form	Modified

ICR Details

OMB Control No: 3037-0002	ICR Reference No: 201204-3037-003
Status: Historical Active	Previous ICR Reference No: 200904-3037-002
Agency/Subagency: CPBSD	Agency Tracking No: 200904-3037-404
Title: Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled
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: 08/31/2012
	Date Received in OIRA: 07/30/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	36 Months From Approved	08/31/2012
Responses	550	0	555
Time Burden (Hours)	3,300	0	3,330
Cost Burden (Dollars)	99,000	0	99,900

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Abstract: The annual certification is used to ensure that nonprofit agencies participating in the JWOD Program are meeting the Program's requirements.

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Authorizing Statute(s): US Code: 41 USC 47(a)(2) Name of Law: JWOD Act
  

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 13563	03/07/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 41376	07/13/2012
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
Annual Certification - Qualified Nonprofit Agency Serving People Who Are Severely Disabled	404	Annual Certification - Qualified Nonprofit Agencies Serving People Who Are Severely Disabled

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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	550	555	0	-5	0	0
Annual Time Burden (Hours)	3,300	3,330	0	-30	0	0
Annual Cost Burden (Dollars)	99,000	99,900	0	-900	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: About 550 nonprofit agencies serving people who are severely disabled will annually request to be verified for participation in the JWOD Program. It is about 5 agencies lese than last reporting period. That is the reason why time and cost burden decrease.

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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: 07/30/2012

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