Supporting Statement (10-2014)

SUPPORTING STATEMENT FOR
PAPERWORK REDUCTION ACT SUBMISSION

Government, Corporate or Foundation, and Individual Donor Form

Application

OMB Number 1405-XXXX
DS-4271, DS-4272, DS-4273

A. JUSTIFICATION

1. The Office of Emergencies in the Diplomatic and Consular Services (EDCS) manages the solicitation and acceptance of gifts to the U.S. Department of State. The information requested via donor forms is a necessary first step in accepting donations. The information sought is pursuant to 22 U.S.C 2697, 5 U.S.C. 7342 and 22 CFR, Part 3.

2. The information collected will be used by EDCS’s Gift Fund Coordinator to demonstrate the donor’s intention to donate either an in-kind or monetary gift to the Department. Collection of this information is mandatory and a form must be completed before the gift is received by the Department.

3. The donor forms are available on the Internet at http://eforms.state.gov. Donors can print the forms, fill them out, and mail them to EDCS. The Department intends to create an electronic submission option by the next collection renewal.

4. EDCS is the only office in the Department managing the donor program so no other office or program is requesting duplicate information from the public.

5. This collection of information will not have a significant impact on small businesses or other small entities. Small businesses may give in-kind or cash gifts to the Department. The Department estimates it will take a small business five minutes to complete a form, put it in an envelope, address it, and mail it to the Department. To further reduce burden, the Department has plans to develop a donor computer application on www.state.gov so forms can be submitted electronically.

6. Without the information collection, EDCS would not be able to accept gifts from donors to the Department. The information is collected only once per donation.

7. There are no special circumstances.

8. EDCS published a notice in the Federal Register seeking public comments on this proposed collection. No public comments were received.

9. No gifts or payments will be made to respondents.

10. All information will be kept private subject to the Privacy Act Statement printed on the forms.

11. No questions of a sensitive nature are asked.

12. Within the last fiscal year, the Department received 3,665 cash donations and 18 in-kind donations. We estimate 3665 donations annually with an estimated time to fill out a donation form of 5 minutes, for an annual burden of 305 hours. The hour cost burden for this collection is estimated to be $9,284.00. This is based on the U.S. Department of Labor, Bureau of Labor Statistics website (www.bls.gov). The wage rate category for “all occupations” (for individual or household respondents, chosen because the respondent could be from any occupation) is estimated to be $30.44 per hour ($21.74 x 1.4 wage rate multiplier), therefore, the estimated cost to respondents “all occupations” is estimated to be $9,284 annually based on 305 Annual Burden Hours (305 x $30.44).

13. There will be no capital or start-up costs necessary for respondents. The only additional operation cost would be postage for the respondents to return the form to the Department. The Department estimates 3,665 forms mailed at 50 cents each for a total of $1,833 in cost to the public.

14. The Department estimates it takes 10 minutes to process each form – opening the envelope, recording the information in a database, and sending a thank-you note back to the donor. Assuming a GS-12 salary, step 5 base salary of $33.06 per hour, the Department’s cost would be $20,193 per year. [3,665 multiplied by 10 minutes equals 610 hours, 48 minutes. 610.8 multiplied by $33.06 = $20,193 per year.]

15. The burden changes indicated are the result of this submission as a new collection.

16. The information gathered via this information collection will not be published.

17. EDCS will display the OMB expiration date on hard copy and electronic versions of the forms plus the computer application when built.

18. EDCS does not request an exception to the certification of the information collection.

B. COLLECTION OF INFORMATION EMPLOYING STATISTICAL METHODS

This information collection does not employ statistical methods.