Application for Employment as a Locally Employed Staff or Family Member

Forms and Documents

Document Name	Status
Form DS-174 Application for Employment as a Locally Employed Staff or Family Member Form and Instruction	Modified
DIR Review - Legal Authorities.docx Supplementary Document	2016-03-31
Final - Supporting Statement 3-25-2016.doc Supporting Statement A	2016-03-31

IC Document Collections

IC ID	Document Title	Status
190750	Application for Employment as a Locally Employed Staff or Family Member Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0189	ICR Reference No: 201603-1405-007
Status: Historical Active	Previous ICR Reference No: 201406-1405-004
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Application for Employment as a Locally Employed Staff or Family Member
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/03/2016
	Date Received in OIRA: 03/31/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2019	36 Months From Approved	05/31/2016
Responses	40,000	0	40,000
Time Burden (Hours)	40,000	0	40,000
Cost Burden (Dollars)	12,500	0	0

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Abstract: This form will be used by candidates for employment for positions established and recruited by the approximately 170 Department of State Missions abroad. These programs generate approximately 40,000 applications per year. Data extracted from the form is necessary to determine eligibility, qualification, and selection for overseas employment, according to Federal policies.

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Authorizing Statute(s): US Code: 22 USC 2669(c) Name of Law: Foreign Relations and Intercourse
   PL: Pub.L. 96 - 465 103,105.206,301,303,311,408 Name of Law: Foreign Service Act of 1980
  

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:
	81 FR 3230	01/20/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 18680	03/31/2016
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Application for Employment as a Locally Employed Staff or Family Member	DS-174	Application for Employment as a Locally Employed Staff or Family Member

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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	40,000	40,000	0	0	0	0
Annual Time Burden (Hours)	40,000	40,000	0	0	0	0
Annual Cost Burden (Dollars)	12,500	0	0	12,500	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: $907,203

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: 03/31/2016

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