District Five, Coast Guard Auxiliary Safety Survey

Forms and Documents

Document Name	Status
Form CG-16798 (11/13) Coast Guard Auxiliary Safety Survey Form	New
1625-NEW Auxiliary Database SORN.docx Supplementary Document	2015-01-15
1625-NEW_SS_r0_2014.docx Supporting Statement A	2015-01-15
Aux Survey Informed Consent Page_CGIRB Approval.pdf Supplementary Document	2015-01-15
USCG AUX Survey Draft8-03202013.doc Supplementary Document	2015-01-15
30-Day Federal Register Notice.doc Supplementary Document	2015-01-15
60-Day Federal Register Notice.doc Supplementary Document	2015-01-15

IC Document Collections

IC ID	Document Title	Status
214651	Coast Guard Auxiliary Safety Survey Form	New

ICR Details

OMB Control No:	ICR Reference No: 201501-1625-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: DHS/USCG	Agency Tracking No:
Title: District Five, Coast Guard Auxiliary Safety Survey
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: Improperly submitted	Conclusion Date: 03/26/2015
	Date Received in OIRA: 01/28/2015
Terms of Clearance: The proposed survey requires an analysis of statistical methods used (Supporting Statement Part B). Coast Guard may submit this request to OMB with the required Part B analysis.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection is associated with Safety and Risk Management (SARM) Council initiatives to enhance operational safety throughout District Five. The SARM Council plans to utilize an online survey to conduct a safety/hazard assessment for organizational volunteers engaged in Coast Guard Operations.

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Authorizing Statute(s): None

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:
	79 FR 13318	03/10/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 74749	12/16/2014
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Coast Guard Auxiliary Safety Survey	CG-16798 (11/13)	District Five Auxiliary Safety Survey

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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: This is a new collection.

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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: 01/28/2015

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