INTERNational Connections

Forms and Documents

Document Name	Status
Form DS-5103 INTERNational Connections Form and Instruction	Modified
1405-0190 Legal Authorities 01-31-13.docx Supplementary Document	2013-01-31
1405-0190 Supporting Statement 01-31-13.docx Supporting Statement A	2013-01-31

IC Document Collections

IC ID	Document Title	Status
191264	INTERNational Connections Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0190	ICR Reference No: 201301-1405-002
Status: Historical Active	Previous ICR Reference No: 200911-1405-002
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: INTERNational Connections
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: 03/11/2013
	Date Received in OIRA: 01/31/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved	03/31/2013
Responses	1,000	0	1,000
Time Burden (Hours)	500	0	500
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection will provide the Department, specifically HR/REE, the means to maintain contact with former interns, complementing other diversity-focused outreach activities to sustain their interest in Department careers and to follow up and encourage continued engagement and a sense of community. With this information collection, the Department will also be able to measure its success in converting qualified interns into career employees.

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Authorizing Statute(s): US Code: 22 USC 3901 Name of Law: Congressional Finding and Objectives
   US Code: 5 USC 3111 Name of Law: Acceptance of Volunteer Services
   US Code: 22 USC 2651a Name of Law: Organization of the Department of State
  

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 65602	10/29/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 6171	01/29/2013
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
INTERNational Connections	DS-5103	INTERNational Connections

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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	1,000	1,000	0	0	0	0
Annual Time Burden (Hours)	500	500	0	0	0	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:

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Annual Cost to Federal Government: $108,000

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? 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: 01/31/2013

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