Representations to Implement Appropriations Act Provisions on Felony Convictions and Unpaid Federal Tax Liabilities

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Supporting Statement Part A.docx	Supporting Statement A	Uploaded 2013-08-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
205053	Representations to Implement Appropriations Act Provisions on Felony Convictions and Unpaid Federal Tax Liabilities	Other-part 1 -- ASD(R&E) memorandum	Modified

ICR Details

OMB Control No: 0704-0494	ICR Reference No: 201308-0704-004
Status: Historical Active	Previous ICR Reference No: 201212-0704-001
Agency/Subagency: DOW/DODDEP	Agency Tracking No:
Title: Representations to Implement Appropriations Act Provisions on Felony Convictions and Unpaid Federal Tax Liabilities
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 without change	Conclusion Date: 09/27/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/26/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	36 Months From Approved	09/30/2013
Responses	15,000	0	15,000
Time Burden (Hours)	1,250	0	1,250
Cost Burden (Dollars)	64,800	0	0

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Abstract: The information collected from an applicant for a DoD grant or cooperative agreement would indicate if it is a corporation that has either a felony conviction or Federal tax liabitily that would make it ineligible to receive a DoD award based on FY 2012 appropriations provisions. The information will be collected by stating a requirement in program announcements for applicants to submit representations with their applications.

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Authorizing Statute(s): PL: Pub.L. 112 - 74 8124
   PL: Pub.L. 112 - 74 8125
   PL: Pub.L. 112 - 74 504
   PL: Pub.L. 112 - 74 505
   PL: Pub.L. 112 - 74 514
  

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:
	78 FR 25704	05/02/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 52168	08/22/2013
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
Representations to Implement Appropriations Act Provisions on Felony Convictions and Unpaid Federal Tax Liabilities

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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	15,000	15,000	0	0	0	0
Annual Time Burden (Hours)	1,250	1,250	0	0	0	0
Annual Cost Burden (Dollars)	64,800	0	0	0	64,800	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:

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: 08/26/2013

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