3090-0118 Supporting Statement B

3090-0118 Supporting Statement B.docx

Statement of Witness, Standard Form (SF) 94

OMB: 3090-0118

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Supporting Statement for Paperwork Reduction Act Submission

3090-0118 –Standard Form 94, Statement of Witness

B. Collections of Information Employing Statistical Methods


The agency should be prepared to justify its decision not to use statistical methods in any case where such methods might reduce burden or improve accuracy of results. When Item 17 is checked “Yes,” the following documentation should be included in the Supporting Statement to the extent that it applies to the methods proposed.

1. Describe (including a numerical estimate) the potential respondent universe and any sampling or other respondent selection methods to be used.


There were an estimated 19,000 reportable motor vehicle accidents in the Federal Government during fiscal year 2015. Of those, an estimated 3-5 percent involved possible public usage of the form. It is estimated that no more than 20 minutes is required to complete the form. Additional time may be required of the witness if he or she is required to testify as part of the judicial process.


The GSA Fleet (representing one third of Federal motor vehicles) and Federal agencies who participate in the FEDFLEET were contacted for information regarding the use of the form by the public. All responses indicated minimal use by the public.


2. Describe the procedures for the collection of information.

SF 94 is a standard form used by all agencies. No additional manpower or resources are required to provide the form. The form, as a matter of policy, is carried in all Federal motor vehicles, except those designated as “undercover.” The collection of this information does not employ statistical methods. Results of personal statements on the form are used as is and are not compiled or manipulated.


3. Describe methods to maximize response rates and to deal with issues of non-response.

Comments received indicated an average of 3-5 percent response rate from the public. This figure may even be high. Since the use of the form by the public is voluntary, no action is being taken to improve the response rate.


4. Describe any tests of procedures or methods to be undertaken.

No test of procedures or methods is planned. The form has been in use for some time. Comments received from GSA and FEDFLEET agencies indicate that they are happy with the form as designed.


5. Provide the name and telephone number of individuals consulted on statistical aspects of the design and the name of the agency unit, contractor(s), grantee(s), or other person(s) who will actually collect and/or analyze the information for the agency.


Individuals Consulted:


GSA Fleet:

Schaubhut, George

(703) 605-2949


Contacts for Federal agencies participating in FEDFLEET:


Blas, Daniel

Office of Personnel Management

202-606-2453


Chisolm, Dionne

Department of Homeland Security

202-731-1700


Currie, Timothy

National Aeronautics & Space Administration

202-358-1219


Davis, Willie

Department of Interior

(202) 513-7541


DeDomenic, Mark

State Department

202-647-3159


Gerstell, Joe

Department of Justice

202-616-1633


Grigsby, Paul

Environmental Protection Agency

202-564-7737


Gilbert-Miller, Susan

Department of Labor

202-693-6662


Jack, Rhea

Department of Agriculture

202-720-8616


Kerr, Jim

Department of Health & Human Services

202-260-6127


Larrabee, Regina

Veterans Administration

202-632-7083


Sims, Deric

Department of Defense

703-697-0659


Smith, Phyllis

Department of Treasury

202-622-1896


Tan, Dante

Department of Energy

(202) 287-1364



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