Acquisition Services Information Requirements

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1600/04 Background Investigation Questionnaire for Contractor Personnel & Subcontractors	Form	Modified	Available
Form 3700/59 Fair Inclusion of Minorities and Women	Form	New	Available
Form 3700/4A Contractor Representations and Certifications	Form and Instruction	Modified	Available
Form 3700-04A Leasing Representations and Certifications	Form and Instruction	Modified	Available
Form 3700-57 FDIC Past Performance Questionnaire	Form and Instruction	Modified	Available
Form 3700/12 Integrity and Fitness Representations	Form and Instruction	Modified	Available
Form 1600-07 Background Investigation Questionnaire Contractors	Form	Modified	Available
FR2 0072 - Acquisiton Services Information Requirements 80 FR 67401 (2 NOV 2015 ).pdf	Supplementary Document	Uploaded 2015-11-19	Available
FR1 0072 - Acquisition Services Information Requirements 80 FR 52274 (28 AUG 2015).pdf	Supplementary Document	Uploaded 2015-11-19	Available
SPST-0072 Acquisition Services Information Requirements 2015 Renewal.doc	Supporting Statement A	Uploaded 2016-02-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
31818	Background Investigation Questionnaire for Contractor Personnel & Subcontractors	Form	Modified
219241	Fair Inclusion of Minorities and Women	Form	New
187308	Contractor Representations and Certifications	Form and Instruction	Modified
185905	Leasing Representations and Certifications	Form and Instruction	Modified
185894	FDIC Past Performance Questionnaire	Form and Instruction	Modified
185892	Integrity and Fitness Representations	Form and Instruction	Modified
185890	Background Investigation Questionnaire Contractors	Form	Modified

ICR Details

OMB Control No: 3064-0072	ICR Reference No: 201511-3064-008
Status: Historical Active	Previous ICR Reference No: 201211-3064-003
Agency/Subagency: FDIC	Agency Tracking No:
Title: Acquisition Services Information Requirements
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/02/2016
	Date Received in OIRA: 12/10/2015
Terms of Clearance: Updated supporting statement during review.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	36 Months From Approved	03/31/2016
Responses	5,135	0	6,035
Time Burden (Hours)	2,334	0	2,564
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a collection of information involving the submission of various forms by contractors doing business with the FDIC.

---

Authorizing Statute(s): US Code: 12 USC 5452 Name of Law: Dodd-Frank Wall Street Reform and Consumer Protection Act
   US Code: 12 USC 1819 Name of Law: Federal Deposit Insurance Act
  

Citations for New Statutory Requirements: US Code: 12 USC 5452 Name of Law: Dodd-Frank Wall Street Reform and Consumer Protection Act

---

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:
	80 FR 52274	08/28/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 67401	11/02/2015
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Background Investigation Questionnaire Contractors	1600-07	Background Investigation Questionnaire for Contractors
Leasing Representations and Certifications	3700-04A	Contractor Representations and Certifications
Integrity and Fitness Representations	3700/12	FDIC Integrity and Fitness Representations and Certifications
FDIC Past Performance Questionnaire	3700-57	FDIC Past Performance Questionnaire
Contractor Representations and Certifications	3700/4A	FDIC Contractor Representations and Certifications
Background Investigation Questionnaire for Contractor Personnel & Subcontractors	1600/04	Background Investigation Questionnaire for Contractor Personnel and Subcontractors
Fair Inclusion of Minorities and Women	3700/59	Fair Inclusion of Minorities and Women

---

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	5,135	6,035	100	0	-1,000	0
Annual Time Burden (Hours)	2,334	2,564	100	0	-330	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]? Yes

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: 12/10/2015

---