FORM 14: ELECTRONIC SUBMISSION OF ALLEGATIONS AND DISCLOSURES

Forms and Documents

Document Name	Status
Form OSC FORM-14 FORM 14: ELECTRONIC SUBMISSION OF ALLEGATIONS AND DISCLOSURES Form and Instruction	Modified
USOSC Form 14 PROD v3.2 (003).pdf Supporting Statement B	2017-09-15
Form 14 PPRA Supporting Statement (Final).pdf Supporting Statement A	2017-06-07

IC Document Collections

IC ID	Document Title	Status
223438	FORM 14: ELECTRONIC SUBMISSION OF ALLEGATIONS AND DISCLOSURES Form and Instruction	Modified

ICR Details

OMB Control No: 3255-0005	ICR Reference No: 201706-3255-001
Status: Historical Active	Previous ICR Reference No: 201701-3255-001
Agency/Subagency: OSC	Agency Tracking No: OSC FORM-14
Title: FORM 14: ELECTRONIC SUBMISSION OF ALLEGATIONS AND DISCLOSURES
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 with change	Conclusion Date: 09/18/2017
	Date Received in OIRA: 06/10/2017
Terms of Clearance: The location of the PRA statement on the ICs must be consistent with the PRA regulations. The ICs should also include the citation to applicable SORNs.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2020	36 Months From Approved
Responses	6,000	0	0
Time Burden (Hours)	6,917	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This form will replace forms OSC-11, OSC-12, AND OSC-13, which were previously approved by OMB. The new electronic form will be used by current and former federal employees and applicants for federal employment, and other covered filers, to submit allegations of possible prohibited personnel practices or other prohibited activities for investigation and possible prosecution by OSC, or review and possible referral to relevant inspector general offices.

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Authorizing Statute(s): US Code: 5 USC CFR 1800 Name of Law: CODE OF REGULATIONS
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
3255-AA00	Final or interim final rulemaking	82 FR 26739	06/09/2017

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 60649	09/02/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 60649	09/02/2016
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
FORM 14: ELECTRONIC SUBMISSION OF ALLEGATIONS AND DISCLOSURES	OSC FORM-14, OSC FORM-14	FORM 14: ELECTRONIC SUBMISSION OF ALLEGATIONS AND DISCLOSURES

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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	6,000	0	0	6,000	0	0
Annual Time Burden (Hours)	6,917	0	0	6,917	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: This form will replace forms OSC-11, OSC-12, AND OSC-13, which were previously approved by OMB. The new electronic form will be used by current and former federal employees and applicants for federal employment, and other covered filers, to submit allegations of possible prohibited personnel practices or other prohibited activities for investigation and possible prosecution by OSC, or review and possible referral to relevant inspector general offices.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 06/09/2017

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