3090-00XX - Wireless Telecommunications Company Application

Forms and Documents

Document Name	Status
Form GSA Form [TBD] 3090-00XX; Wireless Telecommunications Company Application Form	New
3090-00XX-Supporting Statement-083015.doc Supporting Statement A	2015-09-29

IC Document Collections

IC ID	Document Title	Status
218053	3090-00XX; Wireless Telecommunications Company Application Form	New

ICR Details

OMB Control No: 3090-0307	ICR Reference No: 201508-3090-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: GSA	Agency Tracking No:
Title: 3090-00XX - Wireless Telecommunications Company Application
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/29/2015
	Date Received in OIRA: 08/28/2015
Terms of Clearance: This collection is approved based on the revised materials provided by the Agency.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2018	36 Months From Approved
Responses	20	0	0
Time Burden (Hours)	20	0	0
Cost Burden (Dollars)	820	0	0

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Abstract: Section 6409 of Public Law 112-96 requires all executive landholding agencies to use a common application. Agencies will send the application to carriers expressing interest in leasing space for the installation of an antenna to support expansion of their wireless networks.

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Authorizing Statute(s): PL: Pub.L. 112 - 96 6409 Name of Law: MIDDLE CLASS TAX RELIEF AND JOB CREATION ACT OF 2012
  

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:
	80 FR 13004	03/12/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 52285	08/28/2015
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
3090-00XX; Wireless Telecommunications Company Application	GSA Form [TBD]	Wireless Telecommunications Company Application

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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	20	0	0	20	0	0
Annual Time Burden (Hours)	20	0	0	20	0	0
Annual Cost Burden (Dollars)	820	0	0	820	0	0

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: This is a request for a new common form information collection.

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Annual Cost to Federal Government: $680

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:  Yes

OIRA authorizes any Agency to begin using a Common Form associated with this ICR automatically after 3 calendar days from the date the agency's RCF including the common form was received in OIRA.

Description/Changes for Common Form Usage:  None.

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 08/28/2015

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