Inquiry Concerning Application for Employment

Forms and Documents

Document Name	Status
Form FL5-127 Inquiry Concerning Application for Employment Form	Modified
Justification 2900-0117_82016.docx Supporting Statement A	2016-08-25

IC Document Collections

IC ID	Document Title	Status
28322	Inquiry Concerning Application for Employment Form	Modified

ICR Details

OMB Control No: 2900-0117	ICR Reference No: 201603-2900-001
Status: Historical Inactive	Previous ICR Reference No: 201304-2900-014
Agency/Subagency: VA	Agency Tracking No: 2900-0117
Title: Inquiry Concerning Application for Employment
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 05/08/2017
	Date Received in OIRA: 09/19/2016
Terms of Clearance: Continued use of this collection of information is in violation of the Paperwork Reduction Act and should be reported to OMB. Before the Department of Veterans Affairs can re-instate this collection, the agency should submit a draft supporting statement to OMB responding to OMB's comments from January 05, 2017 requesting 1) provision of source information for BLS wage estimate in Q. 12(e); 2) a detailed description of the analytical cost component in response to Q. 14; and 3) a revised response to question 3 that considers the potential for the electronic collection of signatures.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved	05/31/2017
Responses	0	0	12,500
Time Burden (Hours)	0	0	3,125
Cost Burden (Dollars)	0	0	0

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Abstract: The information obtained through use of VA Form Letter 5-127 is use by appointing officials in determining an applicant's suitability and qualifications for employment.

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Authorizing Statute(s): US Code: 5 USC 552a Name of Law: Privacy Act of 1974
   EO: EO 10450 Name/Subject of EO: Verification of Employment and Suitability
  

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:
	78 FR 40771	04/25/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 58554	08/25/2016
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
Inquiry Concerning Application for Employment	FL5-127	Inquiry Concerning Application for Employment

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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: $27,068

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: 09/19/2016

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