IHS Background Investigations of Individuals in Positions Involving Regular Contact with or Control Over Indian Children

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0917-0028 IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children	Form and Instruction	Modified	Available
FINAL OMB No. 0917-0028 Supporting Statement, 9-24-2015.doc	Supporting Statement A	Uploaded 2015-09-24	Available
OMB_supporting_statement_B_5-22-2012 DRA Final Draft.doc	Supporting Statement B	Uploaded 2012-06-11	Available
Title_42_chap_132_13041._Requirement_for_background_checks[1].doc	Supplementary Document	Uploaded 2012-06-11	Available
USCODE-2011-title25-chap34-sec3207.pdf	Supplementary Document	Uploaded 2012-06-11	Available
OMB Form No. 3206-0182 0306[1].pdf	Supplementary Document	Uploaded 2012-06-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6586	IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children	Form and Instruction	Modified

ICR Details

OMB Control No: 0917-0028	ICR Reference No: 201509-0917-001
Status: Historical Active	Previous ICR Reference No: 201209-0917-001
Agency/Subagency: HHS/IHS	Agency Tracking No: 0917-0028
Title: IHS Background Investigations of Individuals in Positions Involving Regular Contact with or Control Over Indian Children
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/06/2015
	Date Received in OIRA: 09/25/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2018	36 Months From Approved	11/30/2015
Responses	3,000	0	3,000
Time Burden (Hours)	600	0	600
Cost Burden (Dollars)	0	0	0

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Abstract: To collect information needed to determine whether a prospective or current employee that has regular contact with or control over Indian children meets the minimum standards or character and to conduct background investigation.

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Authorizing Statute(s): US Code: 42 USC 13041 Name of Law: Public Health and Welfare Act, Requirement for Background Checks
   PL: Pub.L. 101 - 630 408 Name of Law: Indian Child Protection and Family Violence Prevention Act
   PL: Pub.L. 106 - 568 814 Name of Law: Technical Amendment to the Indian Child Protection and Family Violence Protection Act
   US Code: 25 USC 3201-3211 Name of Law: Indian Child Protection and Family Violence Prevention
  

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 43100	07/21/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 53812	09/08/2015
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children	0917-0028	Final Addendum to Declaration for Federal Employment (OF 360) Form, IHS Child Care Positions

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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	3,000	3,000	0	0	0	0
Annual Time Burden (Hours)	600	600	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:

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Annual Cost to Federal Government: $1,800

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 09/25/2015

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