Freedom of Information/Privacy Act Record Request Form (INV 100)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form INV 100 Freedom of Information/Privacy Act Record Request Form (INV 100)	Form and Instruction	Modified	Available
Justification Statement-INV 100 Non-Substantive Change Request--April 2015.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-04-29	Available
Supporting Statement-INV 100-November 20 2012 FINAL ROCIS.DOC	Supporting Statement A	Uploaded 2013-03-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
200701	Freedom of Information/Privacy Act Record Request Form (INV 100)	Form and Instruction	Modified

ICR Details

OMB Control No: 3206-0259	ICR Reference No: 201504-3206-006
Status: Historical Active	Previous ICR Reference No: 201201-3206-009
Agency/Subagency: OPM	Agency Tracking No:
Title: Freedom of Information/Privacy Act Record Request Form (INV 100)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/29/2015
	Date Received in OIRA: 04/29/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2016	05/31/2016	05/31/2016
Responses	16,626	0	16,626
Time Burden (Hours)	1,386	0	1,386
Cost Burden (Dollars)	0	0	0

---

Abstract: Requesting two non-substantive changes to OMB 3206-0259, INV 100, Expiration Date 5-31-2016. The Section 2 change supports the Paperwork Reduction Act and plain language initiative by offering the Secure e-Mail delivery method option and the Section 3 change is grammatical. The proposed optional form INV 100 use is to standardize collection of data elements specific to FOIA and Privacy Act record requests submitted to OPM Federal Investigative Services (FIS). Standardization of the access process will increase the volume of perfected requests received and strike an appropriate balance between the burden to the public in submitting a request and FIS-FOI/PA being able to verify the identity of the requester thereby ensuring Privacy Act Protected records are not inappropriately released to third parties.

---

Authorizing Statute(s): US Code: 5 USC CFR 294 Name of Law: Electronic Code of Federal Regulations
   US Code: 5 USC CFR 297 Name of Law: Electronic Code of Federal Regulations
  

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:
	77 FR 53237	08/31/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 19025	03/28/2013
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Freedom of Information/Privacy Act Record Request Form (INV 100)	INV 100	Freedom of Information/Privacy Act Record Request Form

---

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	16,626	16,626	0	0	0	0
Annual Time Burden (Hours)	1,386	1,386	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	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:

---

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

---

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: 04/29/2015

---