Collection of Required Data Elements to Verify Eligibility

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
DMDC 20_PIA_Signatures_signedVHB Sections 1 and 2.PDF	Supplementary Document	Uploaded 2015-11-04	Available
2015-27745_DMDC 20_Initial Publication.PDF	Supplementary Document	Uploaded 2015-11-04	Available
OPM Breach Records SSN Justification_16Oct.pdf	Supplementary Document	Uploaded 2015-10-28	Available
OMB Request Letter.PDF	Supplementary Document	Uploaded 2015-10-14	Available
STATEMENT OF DETERMINATION Draft 10-13-15 for HPRM.DOCX	Supplementary Document	Uploaded 2015-10-14	Available
Supporting Statement Part A 2015-10-14.DOC	Supporting Statement A	Uploaded 2015-10-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218567	Collection of Required Data Elements to Verify Eligibility	Other-Verificaiton Screen with Drop Down List	New

ICR Details

OMB Control No: 0704-0545	ICR Reference No: 201510-0704-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Collection of Required Data Elements to Verify Eligibility
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 11/16/2015
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/16/2015
	Date Received in OIRA: 10/14/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2016	6 Months From Approved
Responses	19,000,000	0	0
Time Burden (Hours)	2,650,000	0	0
Cost Burden (Dollars)	111,299,997	0	0

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Abstract: This is a new collection of information necessitated by the Office of Personnel Management (OPM) cybersecurity incident in which approximately 21.5 million security clearance background investigation records containing personally identifying information (PII) were compromised. The information collected will be used only to verify whether or not an individual was impacted by the OPM cybersecurity incident involving background investigation records and to send a letter confirming status as “impacted” or “not impacted” by this incident.

Emergency Justfication: The information collection is being initiated at this time due to the immediate need to provide assurance and awareness to all impacted individuals and their minor children. The information collected will be used only to verify whether or not an individual was impacted by the OPM cybersecurity incident. If the individual is categorized as “impacted,” they will receive Government-provided identity protection and credit monitoring services. We, therefore, are asking for emergency consideration in order to implement this collection as soon as possible to provide individuals with immediate safeguards and to further protect US government interests within information security and integrity.

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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
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 61796	10/14/2015
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
Collection of Required Data Elements to Verify Eligibility

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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	19,000,000	0	0	19,000,000	0	0
Annual Time Burden (Hours)	2,650,000	0	0	2,650,000	0	0
Annual Cost Burden (Dollars)	111,299,997	0	0	111,299,997	0	0

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

Burden Increase Due to: Miscellaneous Actions

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: $15,042,000

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: 10/14/2015

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