Applicant Background Questionnaire

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form EEOC Form 715 Applicant Background Questionnaire	Form	Modified	Available
demographic info on applicants 30 day 6.5.12.pdf	Supplementary Document	Uploaded 2012-06-05	Available
demographic info on applicants 60 day 2.21.12.pdf	Supplementary Document	Uploaded 2012-05-31	Available
Applicant Tracking Supporting Statement (5-23-12).doc	Supporting Statement A	Uploaded 2012-05-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
186845	Applicant Background Questionnaire	Form	Modified

ICR Details

OMB Control No: 3046-0046	ICR Reference No: 201205-3046-001
Status: Historical Active	Previous ICR Reference No: 200810-3046-001
Agency/Subagency: EEOC	Agency Tracking No:
Title: Applicant Background Questionnaire
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/12/2012
	Date Received in OIRA: 05/31/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2013	12 Months From Approved	07/31/2012
Responses	26,854,281	0	3,510,600
Time Burden (Hours)	1,342,714	0	175,530
Cost Burden (Dollars)	0	0	0

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Abstract: The Demographic Information on Applicants form is designed to enable federal agencies to evaluate their employment practices by collecting and analyzing data on the race, national origin, sex and disability status of applicants for employment.

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Authorizing Statute(s): US Code: 29 USC 791 Name of Law: Rehabilitation Act 1973
   US Code: 42 USC 2000e Name of Law: Title VII of the Civil Rights Act of 1964
  

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 9923	02/21/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 33216	06/05/2012
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Applicant Background Questionnaire	EEOC Form 715	DEMOGRAPHIC INFORMATION ON APPLICANTS

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ICR Summary of Burden

table that charts list 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	26,854,281	3,510,600	0	0	23,343,681	0
Annual Time Burden (Hours)	1,342,714	175,530	0	0	1,167,184	0
Annual Cost Burden (Dollars)	0	0	0	0	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: No

Burden Reduction Due to:

Short Statement: The content of the form itself and the time burden per respondent (3 minutes) remain unchanged since the previous approval. The total number of estimated respondents has been updated, per OMB's request, to reflect information obtained from other agencies on their estimated numbers of applicants.

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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: 05/31/2012

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