Self-Monitoring Questionnaire for Insurance and Finance Projects

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OPIC-162 Self-Monitoring Questionnaire for Insurance and Finance Projects	Form and Instruction	Modified	Available
OPIC 162-Supporting Statement_2011.doc	Supporting Statement B	Uploaded 2011-07-29	Available
OPIC 162-2012-Supporting Statement New SMQ.doc	Supporting Statement A	Uploaded 2012-05-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
35931	Self-Monitoring Questionnaire for Insurance and Finance Projects	Form and Instruction	Modified

ICR Details

OMB Control No: 3420-0019	ICR Reference No: 201205-3420-007
Status: Historical Active	Previous ICR Reference No: 201107-3420-008
Agency/Subagency: OPIC	Agency Tracking No: OPIC-162
Title: Self-Monitoring Questionnaire for Insurance and Finance Projects
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: 05/17/2012
	Date Received in OIRA: 05/16/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2015	36 Months From Approved	08/31/2014
Responses	450	0	350
Time Burden (Hours)	1,800	0	3,150
Cost Burden (Dollars)	94,500	0	0

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Abstract: The questionnaire is completed annually to provide information that allows OPIC to better assess the effects Overseas Private Investment Corporation (OPIC)-assisted projects will have on the U.S. economy and employment, as well as the environment and economic abroad.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: US Code: 44 USC 3501 Name of Law: Paperwork Reduction Act

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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 229	11/29/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 18	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

table that charts list of burden

IC Title	Form No.	Form Name
Self-Monitoring Questionnaire for Insurance and Finance Projects	OPIC-162	Self-Monitoring Questionnaire for Insurance and Finance )Projedts

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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	450	350	0	100	0	0
Annual Time Burden (Hours)	1,800	3,150	0	-1,350	0	0
Annual Cost Burden (Dollars)	94,500	0	0	94,500	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: This form was revised as an electronic form, which will enhance the coustomers and OPIC proecesses.

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Annual Cost to Federal Government: $35,000

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: 05/16/2012

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