OPIC Form 255 - Justification Statement 01072015

OPIC-255 OMB-

Aligned Capital Investee Opt-In

SUPPORTING STATEMENT FOR APPROVAL

1. Justification

1. Legal authority for this information collection is found in 22 U.S.C, Section 234(d) of the Foreign Assistance Act (FAA) of 1961, as amended. OPIC Form 255 will be used by companies seeking investments or grant funding to place their information into OPIC’s Aligned Capital Program. The Aligned Capital Program is a pilot program that OPIC has designed to align development finance with other capital, including philanthropic, socially responsible and impact investment, to enable effective deployment of that capital towards projects in the countries and sectors in which OPIC works. If a company’s information matches the interests of potential investors that have completed the Aligned Capital Investor Screener (See OPIC-253), information about that company will be shared automatically with such potential investors. OPIC will evaluate the success of the Aligned Capital Program by comparing the benefit to the agency that results from the transactions generated by the program to the internal resources expended to implement the program.

2. This is a new form, but the expectation is that there will be 75 applicants per year. OPIC collects one response per investor per project. Potential respondents that may complete this form are companies doing business in the countries where OPIC works that are interested in receiving grants, equity investments or loans from foundations, non-profit entities, investment fund managers or investment companies that participate in the Aligned Capital Program.

3. This form will be completed with the use of a web-based application.

3. The information collected is not duplicated elsewhere. The information is not already available in any other electronic form and would not be requested by another federal agency or lending institution since it is applicable solely to OPIC’s Aligned Capital Program.

3. The parties completing this form are participating in an optional program. The same questions are asked of all applicants and require only brief answers.

3. The Aligned Capital Program is an automated system that matches potential investors with potential projects in need of investment. It would not be possible to implement this program without a form to collect the information.

3. No special circumstances exist that require the information collection to be conducted in a manner inconsistent with the guidelines of the Paperwork Reduction Act and OMB's implementing regulations.

3. The first Federal Register Notice was published on August 28, 2014. OPIC did not receive any public comments in response to this notice. The second Federal Register Notice is expected to be published on October 30, 2014.

3. No payments and gifts are offered to respondents.

3. OPIC does not provide respondents the assurance of confidentiality. OPIC-255 states: “The information provided on the form will be automatically shared with any potential investors that have completed an Aligned Capital Investor Screener indicating that their interests are a match with your proposed project. These potential investors may choose to contact you, but are not obliged to do so.”

3. Not applicable. None of the questions on this form are of a sensitive nature.

3. The estimated burden of collecting this information is as follows: 75 respondents

x 1 per respondent

75 total annual responses

x (0.5 hours per average respondent)

37.5 respondent hours

x $75/hour for personnel, record-keeping, overhead

$2,812.50 total cost to respondents

Annual reporting is not required. Information is only collected once per investor per project. The Aligned Capital Investee Opt-In is a short on-line form that requests basic information that should be readily available to the person completing the form. As such, thirty minutes is a reasonable estimate.

3. The estimated annualized cost to respondents is as follows:

   1. Total capital and start-up costs: $0

   2. Total operation and maintenance costs: $0.

All costs associated with the form are part of the normal cost of doing business. Since all submissions will be electronic and stored on OPIC’s secure servers, there will be no postage or storage costs.

3. The estimated annualized cost to the Federal government is $0. The responses to the Aligned Capital Investee Opt-In will be matched with responses to the Aligned Capital Investor Screener (See OPIC-253) with an automatic computer program. The responses will not be reviewed by OPIC personnel.

3. Not applicable. This is a new form.

3. Not applicable. Information provided in the application is not published.

3. Not applicable. The OMB expiration date will be printed on each form.

3. Not applicable. No exceptions are being requested on the certification statement.

2. Timing of Form Effectiveness

OPIC’s IT department is scheduled to complete the development of the electronic form on December 19, 2014, so that is when OPIC would expect to begin using OPIC-255 as soon as possible after the OMB 60-day approval period has passed.

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