Humphrey Evaluation Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SV-2012-0003 Humphrey Evaluation Survey	Form and Instruction	New	Repair queued
Humphrey Supporting Statement (11-2012).docx	Supporting Statement A	Uploaded 2012-11-21	Repair queued
Legal Authorities (11-2012).doc	Supplementary Document	Uploaded 2012-11-21	Repair queued
Humphrey Supporting Statement PART B (11-2012).docx	Supporting Statement B	Uploaded 2012-11-21	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204906	Humphrey Evaluation Survey	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201211-1405-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Humphrey Evaluation Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 02/13/2013
	Date Received in OIRA: 11/21/2012
Terms of Clearance: State has requested to withdraw this collection from OMB review.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		12 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection will allow ECA/P/V to conduct a survey of exchange participants who participated in the Hubert H. Humphrey Fellowship Program between 1979 and 2009 as part of a new ECA descriptive study. Collecting this data will help ECA/P/V examine what Fellows have been doing post-program, and their roles in critical areas of change at work, and in their fields of study and how the program affected their work. Data collections efforts will be conducted via electronic survey.

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Authorizing Statute(s): US Code: 22 USC 2451 Name of Law: Mutual Educational and Cultural Exchange Act of 1961
  

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 43899	07/26/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 69539	11/19/2012
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
Humphrey Evaluation Survey	SV-2012-0003	Humphrey Evaluation Survey

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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: Burden change due to submission as a new collection.

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Annual Cost to Federal Government: $85,636

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: 11/21/2012

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