Human Reliability Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DOE F 470.7 Human Reliability Program Alcohol Testing	Form	Modified	Available
Form DOE F 470.6 Refusal of Consent	Form	Modified	Available
Form DOE F 470.5 Authorization and Consent to Release Human Reliability Program Records in Connection with HRP	Form	Modified	Available
Form DOE F 470.4 Acknowledgement and Agreement to Participate in the Human Reliability Program	Form	Modified	Available
Form DOE F 470.3 Human Reliability Program (HRP) Certification	Form	Modified	Available
OMB 1910-5122 Detail Item #13-14 2016.xlsx	Supplementary Document	Uploaded 2016-03-08	Available
OMB 1910-5122 Detail Item #12 2016.xlsx	Supplementary Document	Uploaded 2016-03-08	Available
2016-03-07_30 Day FRN (Published).pdf	Supplementary Document	Uploaded 2016-03-08	Available
2015-12-28_60 Day FRN (Published).pdf	Supplementary Document	Uploaded 2016-03-08	Available
OMB 1910-5122 Supporting Statement-updated final 2016.doc	Supporting Statement A	Uploaded 2016-03-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
23449	Human Reliability Program	Form	Modified	Human Reliability Program Alcohol Testing
23449	Human Reliability Program	Form	Modified	Refusal of Consent
23449	Human Reliability Program	Form	Modified	Authorization and Consent to Release Human Reliability Program Records in Connection with HRP
23449	Human Reliability Program	Form	Modified	Acknowledgement and Agreement to Participate in the Human Reliability Program
23449	Human Reliability Program	Form	Modified	Human Reliability Program (HRP) Certification

ICR Details

OMB Control No: 1910-5122	ICR Reference No: 201603-1910-001
Status: Historical Active	Previous ICR Reference No: 201302-1910-001
Agency/Subagency: DOE/DOEOA	Agency Tracking No: Sandy Dentinger (AU)
Title: Human Reliability Program
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 with change	Conclusion Date: 04/21/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/10/2016
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2019	36 Months From Approved	05/31/2016
Responses	43,999	0	43,999
Time Burden (Hours)	3,819	0	3,873
Cost Burden (Dollars)	0	0	0

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Abstract: These Collections are used by DOE management to certify DOE that respondents were advised of the requirements for occupying or continuing to occupy a Human Reliability Program position.

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Authorizing Statute(s): US Code: 42 USC 7254 Name of Law: The Public Health and Welfare
  

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 80758	12/28/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 11779	03/07/2016
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
Human Reliability Program	DOE F 470.4, DOE F 470.5, DOE F 470.6, DOE F 470.7, DOE F 470.3	Human Reliability Program (HRP) Certification ,   Acknowledgement and Agreement to Participate in the Human Reliability Program ,   Authorization and Consent to Release Human Reliability Program Records in Connection with HRP ,   Refusal of Consent ,   Human Reliability Program Alcohol Testing

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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	43,999	43,999	0	0	0	0
Annual Time Burden (Hours)	3,819	3,873	0	0	-54	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: There are no changes in the annual responses or the time to complete each response for this collection although a decrease of 54 annual burden hours is shown based on corrections of previous mathematical errors.

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Annual Cost to Federal Government: $10,635

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: 03/10/2016

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