Questionnaires and Supplemental Form for National Security, Public Trust, and Non-sensitive Positions

Forms and Documents

Document Name	Status
Form SF 86 Questionnaire for National Security Positions Form and Instruction	Unchanged
Explanation of change Q21.docx Justification for No Material/Nonsubstantive Change	2013-03-21
JUSTIFICATION FOR NO MATERIALchange 3206-0005_LL.docx Justification for No Material/Nonsubstantive Change	2011-06-30
mockup sf86.pdf Supplementary Document	2011-06-30
current SF86[1].pdf Supplementary Document	2010-03-10
SF 86 Final for Sep 09 30-day-Fed Register Notice.pdf Supplementary Document	2010-03-10
SF86_OPMtoOMB_FINAL_02042010.pdf Supplementary Document	2010-02-04
published 30 day notice December 2008.pdf Supplementary Document	2009-12-22
60 day notice june 2008.pdf Supplementary Document	2009-12-22
published SF86 Sept302009.pdf Supplementary Document	2009-12-22
SF 85-86 supporting statement.doc Supporting Statement A	2010-05-03

IC Document Collections

IC ID	Document Title	Status
44214	Questionnaire for National Security Positions Form and Instruction	Unchanged

ICR Details

OMB Control No: 3206-0005	ICR Reference No: 201303-3206-003
Status: Historical Active	Previous ICR Reference No: 201106-3206-011
Agency/Subagency: OPM	Agency Tracking No:
Title: Questionnaires and Supplemental Form for National Security, Public Trust, and Non-sensitive Positions
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/03/2013
	Date Received in OIRA: 03/21/2013
Terms of Clearance: OMB approves the request to add the following language to 21.2: "Please respond to this question with the following additional instruction: Victims of sexual assault who have consulted with a health care professional regarding an emotional or mental health condition during this period strictly in relation to the sexual assault are instructed to answer No."

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2013	09/30/2013	09/30/2013
Responses	168,200	0	168,200
Time Burden (Hours)	386,860	0	386,860
Cost Burden (Dollars)	0	0	0

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Abstract: OPM proposes to change the instructions to question 21.1 of the standard form 86, which asks whether, in the last seven years, the respondent has consulted with a health care professional regarding an emotional or mental health condition or was hospitalized for such a condition. The proposed change would instruct persons whose consultation was strictly in relation to a sexual assault to respond "no."

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Authorizing Statute(s): EO: EO 12968 Name/Subject of EO: Access to Classified Information
   US Code: 5 USC 3301 Name of Law: Title 5: Government Organization and Employees
   US Code: 5 USC 3302 Name of Law: Title 5: Government Organization and Employees
   US Code: 5 USC 7312 Name of Law: Title 5: Government Organization and Employees
   US Code: 5 USC 9101 Name of Law: Title 5: Government Organization and Employees
  

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:
	73 FR 35421	06/23/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 50260	09/30/2009
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
Questionnaire for National Security Positions	SF 86, e-QIP, SF-86C, E-QIP, SF-85PS, SF-85, SF-86A, e-QIP, SF-85P (EQIP), SF-86 (EQIP), SF-85 (EQIP), SF-85P	Questionnaire for National Security Positions ,   Continuation Sheet For Questionnaires SF 85, SF 85P and SF 86 ,   SF 86 Certification ,   Login ,   SF 85PS Screens ,   Investigation Request Certificaton & Release Screens ,   Supplemental Questionnaire for Selected Positions ,   Questionnaire for Public Trust Positions ,   Questionnaire for Non-Sensitive and Low Risk Positions ,   SF-85P Template for the EQIP Screen ,   SF-86 Template for the EQIP Screen ,   SF-85 Template for the EQIP Screen

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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	168,200	168,200	0	0	0	0
Annual Time Burden (Hours)	386,860	386,860	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: $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: 03/21/2013

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