Partnerships with Faith-Based and Other Neighborhood Organizations

Forms and Documents

Document Name	Status
1291-0006_SSA_20160404.docx Supporting Statement A	2016-04-04

IC Document Collections

IC ID	Document Title	Status
215989	Refer Beneficiary or Potential Beneficiary Alternate Provider	Unchanged
215988	Written Notice to Beneficiaries Instruction	Modified

ICR Details

OMB Control No: 1291-0006	ICR Reference No: 201603-1291-002
Status: Historical Active	Previous ICR Reference No: 201504-1291-001
Agency/Subagency: DOL/OASAM	Agency Tracking No:
Title: Partnerships with Faith-Based and Other Neighborhood Organizations
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/29/2016
	Date Received in OIRA: 04/04/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2019	36 Months From Approved
Responses	38	0	0
Time Burden (Hours)	9	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Executive Order 13559, Fundamental Principles and Policymaking Criteria for Partnerships with Faith-Based and Other Neighborhood Organizations caused the US Department of Labor (DOL) to propose a rule that amends the equal treatment provisions at 29 CFR Part 2 subpart D. This information collection describes the categories and extent of burden that respondents will incur as a result of DOL's implementation of this rule.

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Authorizing Statute(s): EO: EO 13559 Name/Subject of EO: Fundamental Principles & Policymaking Criteria for Partnerships w/ Faith-Based & Other Neighboorhood
  

Citations for New Statutory Requirements: EO: EO 13559 Name/Subject of EO: Fundamental Principles & Policymaking Criteria for Partnerships w/ Faith-Based & Other Neighboorhood

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1290-AA29	Final or interim final rulemaking	81 FR 19355	04/04/2016

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 47328	08/06/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 47328	08/06/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Refer Beneficiary or Potential Beneficiary Alternate Provider
Written Notice to Beneficiaries

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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	38	0	38	0	0	0
Annual Time Burden (Hours)	9	0	9	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: This is a new information collection.

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Annual Cost to Federal Government: $82

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: 04/04/2016

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