Data on Nonresident Applicants

Forms and Documents

Document Name	Status
Form FSA-500 Data on Nonresident Applicants Form and Instruction	New
USDA-FSA_Data on Nonresident Applicants_Supporting Statement_v 3.doc Supporting Statement A	2015-09-21
FSA85-1-Reporting_and_Recordkeeping_Requirements_2015.doc Supplementary Document	2015-04-28

IC Document Collections

IC ID	Document Title	Status
214188	Data on Nonresident Applicants Form and Instruction	New

ICR Details

OMB Control No: 0560-0285	ICR Reference No: 201412-0560-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: USDA/FSA	Agency Tracking No:
Title: Data on Nonresident Applicants
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: Approved with change	Conclusion Date: 09/30/2015
	Date Received in OIRA: 05/07/2015
Terms of Clearance: Form expiration date must be clearly displayed on all forms (including those available electronically). Please continue to evaluate the clarity of form instructions to best fit the intention of the collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2018	36 Months From Approved
Responses	55	0	0
Time Burden (Hours)	60	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: FSA is required to use the FSA-500-Data on Nonresident Applicants, to determine each applicant's citizenship, if applications for payments are filed by or for applicants who reside from a point outside the United States, its territories or possessions, even if the application is filed by the agent whose address is in the United States. County office employees provide the FSA-500 to the nonresident applicants to complete the form and filed at the County office.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 4755	01/29/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 25995	05/06/2015
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Data on Nonresident Applicants	FSA-500	Data on Nonresident Applicants

---

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	55	0	0	55	0	0
Annual Time Burden (Hours)	60	0	0	60	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is new request.

---

Annual Cost to Federal Government: $158

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

---

Common Form ICR:  No

---

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: 05/07/2015

---