Self-Monitoring Questionnaire for Insurance and Finance Projects

Forms and Documents

Document Name	Status
Form OPIC-162 Self-Monitoring Questionnaire Form	Modified
OPIC-162_Supporting Statement_NEW.docx Supporting Statement A	2016-05-27

IC Document Collections

IC ID	Document Title	Status
35931	Self-Monitoring Questionnaire Form	Modified

ICR Details

OMB Control No: 3420-0019	ICR Reference No: 201605-3420-001
Status: Historical Active	Previous ICR Reference No: 201502-3420-001
Agency/Subagency: OPIC	Agency Tracking No: OPIC-162
Title: Self-Monitoring Questionnaire for Insurance and Finance Projects
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: 06/30/2016
	Date Received in OIRA: 05/27/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2019	36 Months From Approved	04/30/2018
Responses	465	0	465
Time Burden (Hours)	2,186	0	1,860
Cost Burden (Dollars)	163,913	0	139,500

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Abstract: The Self-Monitoring Questionnaire is submitted on an annual basis by all active OPIC projects to demonstrate compliance with economic, environmental and labor rights policies. A secondary reason is to demonstrate and measure the impact of OPIC's investment in developing markets.

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Authorizing Statute(s): US Code: 22 USC 231 Name of Law: Foreign Assitance Act of 1961
  

Citations for New Statutory Requirements: US Code: 44 USC 3501 Name of Law: Paperwork Reduction Act

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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 5505	02/02/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 20693	04/08/2016
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
Self-Monitoring Questionnaire	OPIC-162	Self-Monitoring Questionnaire

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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	465	465	0	0	0	0
Annual Time Burden (Hours)	2,186	1,860	0	326	0	0
Annual Cost Burden (Dollars)	163,913	139,500	0	24,413	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The overall burden has increased by $24,413.00 due to a 0.7 increase in the average hours to complete the form.

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Annual Cost to Federal Government: $48,518

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? Yes

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: 05/27/2016

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